Objective: To evaluate the effectiveness of unstable femoral neck fracture with posteromedial comminutations treated by cannulated screws and medial bracing plate combined with bone allograft.
Methods: The clinical data of 18 patients with unstable femoral neck fracture with posteromedial comminutations treated by cannulated screws and medial bracing plate combined with bone allograft between July 2016 and March 2020 were retrospectively analyzed. The age ranged from 22 to 64 years, with a median age of 43 years. The causes of injury included 11 cases of falling injury, 3 cases of traffic accident injury, and 4 cases of fall from height injury. According to Garden classification, the femoral neck fracture was classified as type Ⅲ in 3 cases, type Ⅳ in 15 cases, and all patients were type Ⅲ according to Pauwels classification. The time from injury to operation was 1-5 days, with an average of 2.3 days. The fracture healing time and complications were recorded. The quality of fracture reduction was evaluated by Garden index immediately after operation; at last follow-up, the degree of femoral neck shortening was determined by Zlowodzki method, Harris score was used to evaluate hip function.
Results: The operation time was 62-98 minutes (mean, 75 minutes); intraoperative blood loss was 101-220 mL (mean, 153 mL). Cannulated screws guide wire was inserted 3-5 times (mean, 4 times). Intraoperative fluoroscopy was performed 9-21 times (mean, 15 times). The hospital stay was 5-11 days (mean, 7.2 days). All the patients were followed up 12-40 months with an average of 17.3 months. There was no postoperative complication such as accumulated pneumonia, lower extremity deep venous thrombosis, nail cutting, nail withdrawal, internal fixation fracture, and so on. There was no fracture nonunion and osteonecrosis of the femoral head during the follow-up; the fracture healing time was 7-15 weeks, with an average of 12.1 weeks. The quality of fracture reduction was evaluated immediately after operation, the results were grade Ⅰ in 15 cases and grade Ⅱ in 3 cases. At last follow-up, there were 2 cases with femoral neck shortening less than 5 mm and 1 case with 5-10 mm. The incidence of femoral neck shortening was 16.7%. The Harris score of hip joint was 73-97, with an average of 93.5; among them, 12 cases were rated as excellent, 3 cases as good, and 3 cases as fair, with an excellent and good rate of 83.3%.
Conclusion: For the treatment of unstable femoral neck fracture with posteromedial comminutations, cannulated screws and medial bracing plate combined with bone allograft are dramatically effective due to earlier weight bearing, faster fracture healing, and better hip function recovery.
目的: 探讨空心螺钉加内侧支撑钢板结合同种异体骨植骨治疗伴后内侧粉碎的不稳定性股骨颈骨折的临床疗效。.
方法: 回顾分析2016年7月—2020年3月采用空心螺钉加内侧支撑钢板结合同种异体骨植骨治疗的18例伴后内侧粉碎的不稳定性股骨颈骨折患者临床资料。男 12 例，女 6 例；年龄22～64岁，中位年龄43岁。致伤原因：摔伤11例，交通事故伤3例，高处坠落伤4例。股骨颈骨折Garden分型为Ⅲ型3例、Ⅳ型15例，Pauwels分型均为Ⅲ型。受伤至手术时间1～5 d，平均2.3 d。记录骨折愈合时间及并发症发生情况，术后即刻采用Garden指数评定骨折复位质量；末次随访时，参照Zlowodzki方法判定股骨颈短缩程度，采用Harris评分评价髋关节功能。.
结果: 手术时间62～98 min，平均75 min；术中出血量101～220 mL，平均153 mL；术中空心钉导针置入次数3～5次，平均4次；术中透视次数9～21次，平均15次；住院时间5～11 d，平均7.2 d。18例均获随访，随访时间 12～40个月，平均 17.3个月。未出现术后坠积性肺炎、下肢深静脉血栓形成及头钉切割、退钉、内固定物断裂等并发症。术后即刻评价骨折复位质量：Ⅰ级 15例，Ⅱ级 3例。随访期间未出现骨折不愈合及股骨头坏死，骨折愈合时间7～15周，平均12.1周。末次随访时股骨颈短缩≤5 mm 2例，5～10 mm 1例，股骨颈短缩发生率为16.7%。髋关节Harris评分为73～97分，平均93.5分；其中优12例、良3例、中3例，优良率83.3%。.
结论: 对于伴后内侧粉碎的不稳定性股骨颈骨折，空心螺钉加内侧支撑钢板结合同种异体骨植骨疗效肯定，具有术后患肢负重早、骨折愈合快、髋关节功能恢复好的优点。.
Keywords: Femoral neck fracture; bone graft; internal fixation; plate; unstable fracture.