Objective: To explore the impact of preoperative traction on the osteonecrosis of the femoral head (ONFH) in patients with femoral neck fractures.
Methods: Between February 2013 and May 2016, 120 patients with femoral neck fractures, who were treated with screw fixation, were collected. Sixty patients with fractures of Garden type Ⅰ and Ⅱ were non-displaced fracture group; 60 cases with fractures of Garden type Ⅲ and Ⅳ were displaced fracture group. The patients in 2 groups were randomly divided into traction and non-traction subgroups ( n=30). There was no significant difference in gender, age, injury mechanism, damage side, the time from injury to operation, and fracture classification between 2 subgroups ( P>0.05). Intracapsular pressure was recorded before operation. The quality of fracture reduction and the satisfaction ratio of screw implant were evaluated during operation. Visual analogue scale (VAS), Harris score, joint mobility, and the incidence of ONFH would be evaluated at 6 months, 1 year, and 2 years after operation.
Results: All incisions of 2 groups healed by first intention after operation. There was no infection or deep vein thrombosis of lower extremity. All patients were followed up 2 years. In displaced and non-displaced fracture groups, the intracapsular pressure of traction subgroups were higher than that of non-traction group ( P<0.05); the differences of the quality of fracture reduction and the satisfaction ratio of screw implant were not significant ( P>0.05) between 2 subgroups. At 6 months, 1 year, and 2 years after operation, VAS scores were higher in traction subgroup than in non-traction subgroup ( P<0.05); and the joint mobility and Harris scores were lower in traction subgroup than in non-traction subgroup ( P<0.05). X-ray films showed all fractures healed. Except for the non-displaced group at 6 months, the incidences of ONFH were higher in traction subgroup than in non-traction subgroup at other time points ( P< 0.05).
Conclusion: Preoperative traction may increase the risk of ONFH, which can increase the intracapsular pressure and affect the blood supply of femoral head.
目的: 探讨术前牵引对股骨颈骨折术后发生股骨头缺血性坏死（osteonecrosis of the femoral head，ONFH）的影响。.
方法: 以 2013 年 2 月—2016 年 5 月行空心螺钉固定的股骨颈骨折患者作为研究对象，其中 120 例符合选择标准纳入研究。60 例 Garden Ⅰ、Ⅱ型患者为骨折无移位组，60 例 Garden Ⅲ、Ⅳ型为骨折移位组；两组患者均随机分为牵引、非牵引亚组，各亚组 30 例。骨折移位及无移位组中，两亚组患者性别、年龄、致伤原因、损伤侧别、受伤至手术时间以及骨折分型比较，差异均无统计学意义（ P>0.05），具有可比性。术前记录患髋关节囊内压；术中复位固定后，评价骨折复位质量及螺钉植入满意率；术后 6 个月、1 年、2 年记录疼痛视觉模拟评分（VAS）、关节功能 Harris 评分、关节活动度，以及 ONFH 发生情况。.
结果: 两组术后切口均Ⅰ期愈合，无感染及下肢深静脉血栓形成等并发症发生。患者均获随访 2 年。骨折无移位及移位组中，牵引亚组囊内压均高于非牵引亚组（ P<0.05）；骨折复位质量及螺钉植入满意率比较，差异均无统计学意义（ P>0.05）。术后 6 个月、1 年及 2 年，牵引亚组患髋 VAS 评分高于非牵引亚组，关节活动度、Harris 评分低于非牵引亚组，差异均有统计学意义（ P<0.05）。X 线片复查示骨折均愈合，除骨折无移位组术后 6 个月无 ONFH 发生外，其余时间点两组中牵引亚组 ONFH 发生率均高于非牵引亚组（ P<0.05）。.
结论: 术前牵引可能增加 ONFH 发生风险，其作用机制之一可能是牵引增加髋关节囊内压，影响股骨头血供。.
Keywords: Femoral neck fracture; intracapsular pressure; osteonecrosis of the femoral head; preoperative traction.