Ju Fa-Xin, Hou Rui-Xing, Xiong Jin, Shi Hong-Fei, Chen Yi-Xin, Wang Jun-Fei
Ruihua Affiliated Hospital of Soochow University, Suzhou, China.
Orthopedics Department, Baoying County People's Hospital of Jiangsu Province, Yangzhou, China.
Orthop Surg. 2020 Jun;12(3):809-818. doi: 10.1111/os.12683. Epub 2020 May 28.
To evaluate the long-term efficacy of cannulated internal fixation in patients who sustain femoral neck fracture (FNF) and risk factors influencing the outcomes.
This retrospective study analyzed data from 73 elderly patients aged ≥60 years old, hospitalized for FNF and treated with cannulated internal fixation between August 2008 and July 2016. The inclusion criteria were: (i) patients aged ≥60 years; (ii) patients with recent femoral neck fracture, with times of injury ranging from 12-72 h; and (iii) patients who underwent Garden II-IV closed reduction and internal fixation. Patients were classified based on the Garden fracture type and Pauwels angle. Clinical data and radiographs before and after the surgery were collected. Subsequently, surgery was performed with the patient in supine position, under general or lumbar epidural anesthesia. Closed reduction was performed until satisfactory fracture reduction quality was achieved. The weight of all included patients were <75 kg, and thus, minimal internal fixation was performed. The ischemic necrosis of the femoral head was diagnosed by considering the symptoms, signs, and radiological findings. Harris hip scores were used to evaluate postoperative recovery of hip function. Furthermore, relationships between Garden fracture type and necrosis rate of the femoral head, Pauwels angle and necrosis rate of the femoral head, Garden fracture type and Harris hip score, and age and Harris hip score were analyzed.
The mean duration of surgery was 1 ± 0.17 h and blood loss for all the patients was approximately 15 mL. The included patients were followed up for 13-128 months, with an average follow-up of 61 months. Among the included 73 patients, 65 (89.0%) exhibited satisfactory union, seven (9.6%) had femoral head necrosis, and one (1.4%) had nonunion. For seven patients with femoral head necrosis, there were two, two, and three patients classified as Garden IV, Garden III, and Garden II, respectively, and two and five patients classified as Pauwels II and Pauwels III, respectively. Among the seven cases, four underwent hip replacement. Garden fracture type was not significantly associated with femoral head necrosis (χ = 0.44, P > 0.05) or Harris score (χ = 1.43, P > 0.05). Patients with Pauwels I (0%) and II (4.3%) fractures exhibited a significantly lower necrosis rate than those with Pauwels III fractures (41.7%) (P < 0.05).
Cannulated internal fixation was more suitable for older Chinese patients with Pauwels I/II fractures than those with Pauwels III fractures.
评估空心加压内固定术治疗股骨颈骨折（FNF）患者的长期疗效以及影响预后的危险因素。
本回顾性研究分析了2008年8月至2016年7月期间因股骨颈骨折住院并接受空心加压内固定术治疗的73例≥60岁老年患者的数据。纳入标准为：（i）年龄≥60岁；（ii）近期股骨颈骨折患者，受伤时间为12 - 72小时；（iii）接受Garden II - IV型闭合复位内固定术的患者。患者根据Garden骨折类型和Pauwels角进行分类。收集手术前后的临床资料和X线片。随后，患者在全身或腰麻下仰卧位进行手术。进行闭合复位直至获得满意的骨折复位质量。所有纳入患者体重均<75 kg，因此采用最小化内固定。根据症状、体征和影像学表现诊断股骨头缺血性坏死。采用Harris髋关节评分评估术后髋关节功能恢复情况。此外，分析Garden骨折类型与股骨头坏死率、Pauwels角与股骨头坏死率、Garden骨折类型与Harris髋关节评分以及年龄与Harris髋关节评分之间的关系。
手术平均时长为1 ± 0.17小时，所有患者术中出血量约为15 mL。纳入患者随访13 - 128个月，平均随访61个月。73例纳入患者中，65例（89.0%）骨折愈合良好，7例（9.6%）发生股骨头坏死，1例（1.4%）骨折不愈合。7例股骨头坏死患者中，Garden IV型、Garden III型和Garden II型分别有2例、2例和3例，Pauwels II型和Pauwels III型分别有2例和5例。7例中4例接受了髋关节置换术。Garden骨折类型与股骨头坏死（χ = 0.44，P > 0.05）或Harris评分（χ = 1.43，P > 0.05）无显著相关性。Pauwels I型（0%）和II型（4.3%）骨折患者的坏死率显著低于Pauwels III型骨折患者（41.7%）（P < 0.05）。
对于中国老年患者，空心加压内固定术治疗Pauwels I/II型骨折比治疗Pauwels III型骨折更合适。
