空心钉联合同种异体腓骨内固定治疗中青年股骨颈骨折临床初步观察

目的探讨空心钉联合同种异体腓骨内固定治疗中青年股骨颈骨折的初步疗效。方法采用同种异体腓骨植入股骨头前外侧,并以两枚AO空心钉固定治疗中青年股骨颈骨折。结果经临床应用40例40个髋关节,初步随访24～84个月,平均48．5个月,15例出现坏死症状,5例晚期塌陷,塌陷率12．5％,3例塌陷进展行全髋关节置换,髋关节Harris功能评分,优良率92．5％。结论空心钉联合同种异体腓骨内固定治疗中青年股骨颈骨折具有以下优点：（1）促进股骨颈骨折愈合预防骨不连及股骨颈短缩;（2）增加股骨头负重区软骨下骨的机械支撑,分散传导局部应力,提供有效的头内稳定性,利于坏死修复,尽早预防股骨头坏死后塌陷或塌陷进展;（3）增加固定稳定性,可早期下地活动。该手术方法简单、疗效可靠,尤其适用于中青年股骨颈移位或粉碎性骨质缺损骨折。     

切开与闭合复位治疗股骨颈骨折的疗效比较

目的探讨股骨颈骨折采用闭合复位空心钉固定与切开复位空心钉固定的临床效果。方法对2002年7月至2006年1月收治的72例股骨颈骨折患者进行分析。其中随访资料完整的70例中,Garden Ⅱ型10例,Ⅲ型22例,Ⅳ型38例。平均随访时间28个月。结果70例患者中65例愈合,总愈合率为92.9%,其中闭合复位组39例骨折愈合,3例骨折不愈合,愈合率为92.9%;切开复位组26例骨折愈合,2例骨折不愈合,愈合率为92.9%。8例出现股骨头坏死,坏死率为11.4%。其中采用闭合复位加空心钉固定患者42例,5例出现股骨头坏死,坏死率为11.9%;采用切开复位空心钉固定28例,3例出现股骨头坏死,坏死率为10.7%。结论股骨颈骨折所致股骨头坏死和骨不连的发生与骨折的类型及治疗方法的选择有关。良好的复位加空心钉固定可达理想的治疗效果。股骨颈骨折切开复位内固定与闭合复位内固定术后的股骨头坏死或骨不连的发生率无明显差异,也可能与本研究病例少,随访时间短有关,但骨折的解剖复位和坚强的内固定仍是骨折愈合的关键因素。     

股骨颈骨折闭合复位内固定疗效分析

目的评估闭合复位空心螺钉内固定治疗股骨颈骨折的临床疗效。方法对41例新鲜股骨颈骨折的患者行闭合复位经皮空心钉内固定术。骨折按Garden分型:Ⅰ型2例,Ⅱ型12例,Ⅲ型20例,Ⅳ型7例。观察术后骨折愈合、髋部功能状态以及术后并发症情况。结果随访12.0～40.0个月,平均26.0个月,38例(92.7%)骨折获骨性愈合,骨折不愈合2例,股骨头坏死1例。结论闭合复位加压空心钉内固定治疗股骨颈骨折操作简单、疗效可靠、不切开关节囊、不暴露骨折端、对股骨头血液循环干扰小。     

The Dynamic Martin Screw: an Alternative for Intracapsular Femoral Neck Fractures?

Abstract Objectives: The aim of this study was to determine whether the fixation device known as the dynamic Martin screw (DMS) offers a reasonable alternative for stabilizing intracapsular femoral neck fractures. Materials and Methods: A total of 63 patients with intracapsular femoral neck fractures, stabilized between 1993 and 1997 with the DMS, were followed up in this retrospective study in both 1999 and 2002. The patients were on average 64 years of age, with 30 younger and 33 older than 65. The main outcome measurements consisted of union, non-union, aseptic osteonecrosis of the femoral head and implant failure. Results: We determined an overall osteonecrosis rate of 19% (12 of 63) for our patient group after an observation period on average of 83 months. The osteonecrosis rate for undisplaced fractures was 13.2% (5 of 38), and 28% (7 of 25) for displaced fractures. Non-union occurred in 4.8% (3 of 63) and union in 95.2% (60 of 63) of the patient cases. An implant-associated complication involving deep infection occurred in one case, but no example of implant breakage was recorded. Conclusions: As a method for stabilizing intracapsular femoral neck fractures, the DMS provides treatment results comparable to other sliding hip screws or cannulated screw.     

股骨颈骨折内固定术后股骨头坏死的相关因素分析及生活质量评价

目的:探讨年轻患者股骨颈骨折内固定术后发生股骨头坏死的危险因素,描述股骨头存活患者的生活质量,量化其预测因素。方法:选取2013年1月至2016年12月采用闭合复位空心钉内固定手术治疗的股骨颈骨折患者172例(174髋)进行回顾性分析,总结患者的一般资料包括年龄、性别、体重指数、创伤机制、创伤-手术间隔时间、创伤发生季节和内固定物是否取出,影像学资料包括骨折Garden分型、Pauwel分型、股骨头后倾角度、术后骨折复位、螺钉分布情况。进行单因素分析及多因素Logistic回归分析,探讨股骨头坏死及内固定失败的危险因素。对上述内固定术后股骨头存活的患者进行随访,通过SF-36健康调查简表评估患者的生活质量,髋关节功能Harris评分评估患髋关节功能,并通过多重线性回归分析探讨股骨颈骨折术后患者生活质量的预测因素。结果:172例(174髋)患者纳入研究,共29例(16.67%)患者发生股骨头坏死。股骨头坏死多因素Logistic回归分析中有显著差异的变量是复位质量(OR=0.126,P=0.027)和后倾角(OR=4.380,P=0.010)。股骨头存活136例患者(137髋)纳入生活质量调查,Harris评分90.14±7.92,其中优96髋(70.07%),良28髋(20.44%),中13髋(9.49%),差0髋。SF-36评分中生理健康得分为46.12±9.12,心理健康得分为50.21±3.97,两者不呈线性相关(P0.05),多重线性回归分析中,与生理健康得分相关有显著差异的变量是复位质量与后倾角度,与心理健康得分相关有显著差异的变量是骨折是否移位与创伤机制。结论:复位质量位不佳和后倾角15°是并发股骨头坏死的危险因素。股骨颈骨折术后患者髋关节功能及心理健康得分恢复良好,但生理健康得分不能恢复到正常人群平均水平,复位质量与后倾角度可作为生理健康得分预测因素,骨折是否移位与创伤机制可作为心理健康得分的预测因素。     

Vertical shear fractures of the femoral neck. A biomechanical study.

A biomechanical cadaver study was performed to compare the strength and stability of three cannulated cancellous lag screws with a sliding hip screw for fixation of a vertically oriented fracture of the femoral neck (Pauwels Type III). Using eight matched pairs of human cadaveric femurs, vertically oriented femoral neck osteotomies were created, reduced, and randomized to one of the two fixation methods. The constructs were tested with incremental axial loading from 100 N to 1200 N and cyclical loading at 1000 N for 10,000 cycles; fracture displacements and ultimate load to failure were determined. The specimens stabilized using a sliding hip screw showed less inferior femoral head displacement, less shearing displacement at the osteotomy site, and a much greater load to failure than did those stabilized with multiple cancellous lag screws. These results support the use of a sliding hip screw for treatment of vertically oriented fractures of the femoral neck.     

Torsional strength of double- versus single-screw fixation in a pig model of unstable slipped capital femoral epiphysis

Slipped capital femoral epiphysis was produced in 9 matched pairs of fresh-frozen pig femurs (1-year-old pigs) by twisting the femoral head about the femoral neck axis. Each matched pair was fixed with a single steel cannulated screw on one side and 2 screws contralaterally, after which the perichondrium was removed before retesting. Double-screw fixation without the perichondrium provided 43% of the stiffness and 74% of the strength of the intact physis in torsion and approximately double the stiffness and strength of single-screw fixation (P<0.004). This information may be of use to the surgeon concerned about rotational stability in unstable slipped capital femoral epiphysis.     

Vertically oriented femoral neck fractures: mechanical analysis of four fixation techniques

OBJECTIVE: Femoral neck fractures in young individuals are typically high angled shear fractures. These injuries are difficult to stabilize due to a strong varus displacement force across the hip with weight bearing. The purpose of this study was to compare the biomechanical stability of four differing fixation techniques for stabilizing vertical shear femoral neck fractures. METHODS: Vertical femoral neck fracture stability was assessed using 4 surgical constructs in 32 cadaveric femurs: 7.3 mm cannulated screws placed in a triangular configuration (group 1), a 135-degree dynamic hip screw (group 2), a 95-degree dynamic condylar screw (group 3), and a locking proximal femoral plate (group 4). The 4 groups were matched for mean bone density and each specimen was tested under incremental loading, cyclical loading, and loading to failure. The modes of fixation failure were recorded for each specimen and the mean group stiffness, failure loads, and failure energies were calculated. RESULTS: All 8 specimens failed during incremental loading in group 1. Five of 8 constructs failed with incremental loading, and 3 failed with cyclical testing in group 2. The combined 16 specimens in groups 3 and 4 survived both incremental and cyclical loading. The differences in stiffness, failure loads, and failure energies between the 4 groups were statistically significant (P < 0.001). The strongest construct was the locking plate and the weakest construct was the 7.3-mm cannulated screw configuration. The cannulated screw configuration group failed as the screws backed out of the femoral head and by varus collapse of the osteotomy; the fixed angled devices all failed at the bone-implant interface. CONCLUSIONS: The strongest construct for stabilizing a vertical shear femoral neck fracture is the proximal femoral locking plate, followed in descending order by the dynamic condylar screw, the dynamic hip screw, and the 3 cannulated screw configuration.     

空心钉与空心钉钢板内固定治疗股骨颈骨折疗效比较

目的比较空心钉与空心钉钢板内固定治疗股骨颈骨折的疗效。方法将68例股骨颈骨折患者根据治疗方式分为空心钉组(37例)和空心钉钢板组(31例)。比较两组切口长度、手术时间、术中出血量、并发症、骨折愈合率和术后6个月髋关节Harris评分。结果手术切口均一期愈合。切口长度、手术时间、术中出血量空心钉组均少(短)于空心钉钢板组(P<0.05)。两组患者均获得随访,时间6~41(21.7±10.8)个月。术后6个月,股骨头坏死及骨折不愈合例数空心钉组均多于空心钉钢板组,但差异无统计学意义(P>0.05);股骨颈短缩及螺钉松动、退出例数空心钉组均多于空心钉钢板组,差异有统计学意义(P<0.05);髋关节Harris评分空心钉组低于空心钉钢板组(P<0.05)。结论空心钉和空心钉钢板内固定治疗股骨颈骨折均可获得较好的临床疗效,空心钉钢板内固定能获得更加稳固的支撑,对患肢早期功能锻炼更有利。     

股骨颈骨折空心螺钉治疗失败因素的Meta分析

目的分析股骨颈骨折空心螺钉内固定术后发生治疗失败的原因。 方法计算机检索MEDLINE、EMBASE、Cochrane图书馆临床对照试验注册中心、中国生物医学文献数据库、中国期刊全文数据库、万方数字化期刊全文数据库,检索空心螺钉内固定治疗股骨颈骨折失败的临床研究,检索时间均为建库至2017年12月。排除空心螺钉内固定结合其他内固定或骨瓣移植等治疗方法的文献及空心螺钉内固定与其他治疗方法比较的文献。评价纳入研究的质量,并用RevMan 5.1软件对各研究的患者骨折类型、螺钉排列方式、术前牵引与否、术后开始负重时间、受伤－手术时间,术后复位质量、随访持续时间等进行Meta分析,并采用Detsky评分评价证据质量。 结果共纳入32篇临床研究,共7 807例患者,发生股骨头坏死1 418例,总股骨头坏死率18.16%,骨不连127例,退钉52例。GardenⅠ～Ⅱ型患者较Garden Ⅲ～Ⅳ患者发生空心钉固定失败率低[WMD＝0.18,95%CI(0.11,0.27),I²＝59%,P <0.01],3 d后手术发生内固定失败率更高[WMD＝0.58,95%CI(0.37,0.89),I² ＝67%,P<0.05];Garden指数Ⅰ～Ⅱ级较Garden指数Ⅲ～Ⅳ级空心钉固定失败率低[WMD＝0.19,95%CI(0.10,0.33),I² ＝80%,P<0.01],术后3个月内下地较3个月后下地空心钉固定失败率更高[WMD＝1.90,95%CI(1.02,3.56),I² ＝85%,P<0.05]。复位方式[WMD＝1.04,95%CI(0.73,1.47),I² ＝75%,P>0.05]、术前牵引与否[WMD ＝1.27,95%CI(0.80,2.03),I² ＝61%,P>0.05]、年龄[WMD＝1.19,95%CI(0.67,2.13),I² ＝90%,P>0.05]、性别[WMD＝1.15,95%CI(1.00,1.33),I² ＝0%,P＝0.05]以及螺钉排列方式对空心钉内固定失败率无影响[WMD＝0.69,95%CI(0.28,1.69),I² ＝61%,P>0.05]。 结论骨折类型、复位质量、术后开始负重时间、受伤－手术时间是股骨颈骨折空心钉固定失败率的主要影响因素;年龄、性别、术前牵引与否、复位方式、螺钉排列方式对股骨颈骨折空心钉固定失败率无直接影响。     

14例儿童股骨颈骨折疗效分析

目的探讨儿童股骨颈骨折治疗方法和疗效。方法14例儿童股骨颈骨折根据Garden分型及colonna分型,分别采用髋“人”字石膏外固定、克氏针内固定及空心钉内固定术。结果随访1-8年,13例骨折愈合,1例发生骨不连;并发股骨头坏死3例。结论对儿童股骨颈骨折患者应根据其骨折类型采取不同治疗方法,对有移位者尽早手术治疗,可减少骨不连及股骨头坏死的发生率。     

Ipsilateral femoral shaft and neck fractures: are cephalomedullary nails appropriate?

A retrospective review was conducted to examine rates of malreduction and nonunion in ipsilateral femoral neck and shaft fractures using different fixation strategies. Twenty-two consecutive patients with 23 fractures were identified. Participants were treated with various fixation strategies for ipsilateral femoral neck and shaft fractures. Cephalomedullary devices were used in 13 cases, while cannulated screws and a retrograde femoral nail were used in nine cases. One patient was treated with cannulated screws and external fixation of the femoral shaft. Radiographic assessment of the quality of reduction and union of both fractures was evaluated. Clinical and radiographic follow-up was available in 20 fractures (87%) with a mean of 12 months (range 3-50). Two femoral neck nonunions occurred; both had fair reductions of the fractures obtained by closed maneuvers, and two-device fixation was used in each. One femoral shaft nonunion occurred in a fracture treated with a cephalomedullary nail. All three united after revision surgery. No cases of osteonecrosis or conversion to hip arthroplasty were noted. A combination of retrograde femoral nailing and screw fixation of the femoral neck or placement of a cephalomedullary nail can provide excellent reduction and rate of union in the treatment of this injury pattern. Excellent reduction of the femoral neck fracture is key to preventing femoral neck nonunion.     

利用有限元探究内固定治疗股骨颈骨折的生物力学研究

目的:利用有限元分析研究不同内固定治疗Pauwels Ⅲ型股骨颈骨折的生物力学特点。方法:选取1名健康受试者的股骨CT数据进行三维重建,骨折造模,装配动力髋螺钉、锁定加压钢板、三枚空心钉、四枚空心钉和髓内钉,建立有限元模型,在股骨头顶端轴向加载1400 N应力。研究不同内固定的应力分布和位移分布、股骨的应力分布和位移分布,并比较内固定和股骨模型的应力峰值和位移峰值。结果:股骨和内固定应力较大区域均分布于股骨颈及股骨干部位,且在骨折线附近均出现应力增大的现象;内固定位移分布主要集中于股骨头内螺钉尖端位置,股骨位移集中于股骨头顶端,应力加载位置。四枚空心钉的应力最小,峰值为135.3 MPa;锁定加压钢板的应力最大,峰值为405.9 MPa,但锁定加压钢板的位移12.3 mm为最小峰值;三枚空心钉的位移18.8 mm为最大峰值;三枚空心钉固定时,股骨受力最小,应力峰值为36.8 MPa,但股骨位移最大,峰值为19.3 mm;锁定加压钢板固定时,股骨受力104.6 MPa为最大应力峰值而位移12.6mm为最小位移峰值。结论:锁定加压钢板在固定股骨颈骨折时稳定性最高,但股骨和内固定承受更大的压力和剪切力;动力髋螺钉固定短期内促进骨折愈合较有优势,但长期固定时髓内钉固定更佳。     

Cement augmentation of implants—no general cure in osteoporotic fracture treatment. A biomechanical study on non‐displaced femoral neck fractures

Femoral neck fractures in the elderly are a common problem in orthopedics. Augmentation of screw fixation with bone cement can provide better stability of implants and lower the risk of secondary displacement. This study aimed to investigate whether cement augmentation of three cannulated screws in non‐displaced femoral neck fractures could increase implant fixation. A femoral neck fracture was simulated in six paired human cadaveric femora and stabilized with three 7.3 mm cannulated screws. Pairs were divided into two groups: conventional instrumentation versus additional cement augmentation of screw tips with 2 ml TraumacemV+ each. Biomechanical testing was performed by applying cyclic axial load until failure. Failure cycles, axial head displacement, screw angle changes, telescoping and screw cut‐out were evaluated. Failure (15 mm actuator displacement) occurred in the augmented group at 12,500 cycles (± 2,480) compared to 15,625 cycles (± 4,215) in the non‐augmented group (p = 0.041). When comparing 3 mm vertical displacement of the head no significant difference (p = 0.72) was detected between the survival curves of the two groups. At 8,500 load‐cycles (early onset failure) the augmented group demonstrated a change in screw angle of 2.85° (± 0.84) compared to 1.15° (± 0.93) in the non‐augmented group (p = 0.013). The results showed no biomechanical advantage with respect to secondary displacement following augmentation of three cannulated screws in a non‐displaced femoral neck fracture. Consequently, the indication for cement augmentation to enhance implant anchorage in osteoporotic bone has to be considered carefully taking into account fracture type, implant selection and biomechanical surrounding. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:314–319, 2016.     

How to choose the suitable FNS specification in young patients with femoral neck fracture: A finite element analysis

BackgroundConsensus regarding the optimal approach for the treatment of femoral neck fractures remains lacking. A new internal fixation femoral neck system (FNS) was developed and used in clinical practice. We aimed to investigate the biomechanical outcomes of different types of FNS in the treatment of unstable femoral neck fractures.MethodIn this study, we constructed three different types of unstable femoral neck fractures of Pauwels classification with angles of 50°, 60°, and 70°. We set up four test groups, namely, the one-hole plated FNS group, two-hole plated FNS group, inverted cannulated screw group and triangle cannulated screw group. Under 2100 N axial loads, displacements and the von Mises stress of the femur and internal fixation components were measured for each fracture group.ResultsWhen the Pauwels angle was 50°or 60°, the one-hole locking plated FNS was as superior as the two-hole plated FNS in terms of femur and internal fixation displacement, and the inverted cannulated screw had slightly better stability than the triangular cannulated screw. However, when the angle increases to 70°, the two-hole locking plate has the minimum displacement, followed by the triangular cannulated screw and inverted cannulated screw, which is the worst displacement for the single-hole locking plate. Regardless of the angle, the two sets of FNS have higher internal fixation stress than the two sets of cannulated screws, which is approximately 1.6-3.0 times that of the cannulated screw group.ConclusionFrom the perspective of biomechanics, we suggest that when the angle of the fracture line is less than 60°, both single-hole locking plated or double-hole locking plated FNS can be used to treat unstable femoral neck fractures. However, when the angle of the fracture line is greater than 70°, we recommend using a double-hole locking plated FNS. This result needs further verification in further clinical studies.     

Two or three screws for fixation of femoral neck fractures?

This study compares the stability of 3 cannulated cancellous lag screws with that of 2 cannulated cancellous lag screws for fixation of subcapital femoral neck fractures. Using 10 matched pairs of human cadaveric femurs, subcapital femoral neck osteotomies were created, reduced, and then randomized to 1 of the 2 fixation methods. The constructs were tested with anterior loading to 500 N, incremental axial loading from 100 N to 1000 N, and cyclic loading at 1000 N. The specimens stabilized using 3 screws showed greater resistance to anterior loading, less inferior femoral head displacement, and less superior gapping at the osteotomy site. Although 2 screws may be an acceptable fixation method for this fracture type, the addition of a third screw provides supplemental stability and appears justified.     

Displaced femoral neck fractures in young adults treated with closed reduction and internal fixation

This article describes the effect of closed reduction and internal fixation with 3 different screw configurations for acute completely displaced femoral neck fractures in young adults. From 2001 to 2006, 136 patients (age range, 20-50 years) who had acute unilaterally completely displaced femoral neck fractures were evaluated retrospectively. All fractures were managed with closed reduction and internal fixation with 3 cannulated screws. The follow-up period was 55 months on average (range, 36-90 months). One hundred twenty-two patients were available for final evaluation of union condition and late complication. Twenty-three patients (18.9%) had nonunion, 15 (12.3%) had fixation failure, and 21 (17.2%) had avascular necrosis of the femoral head. The average duration from injury to surgery was 18.4 hours in the union group and 23.3 hours in the nonunion group, with no statistical significance (P=.196). The average duration from injury to surgery was 17.3 hours in the avascular necrosis of the femoral head group and 22.3 hours in the non-avascular necrosis of the femoral head group, with no statistical significance (P=.155). Vertical- and separated-type screw configurations resulted in a significantly higher nonunion rate (P=.001 and P=.0017, respectively) than parallel configuration. The complication rate in treating completely displaced femoral neck fractures with internal fixation in young adults is high, and screw configuration may further affect results.     

Factors influencing the development of osteonecrosis in patients treated for slipped capital femoral epiphysis

BACKGROUND: Osteonecrosis is a serious complication of the treatment of slipped capital femoral epiphysis. The purpose of the present study was to identify factors influencing the development of osteonecrosis. METHODS: Two hundred and forty patients who had been treated for slipped capital femoral epiphysis between 1965 and 1999 were retrospectively evaluated. Treatment included stabilization with a spica cast or fixation with one to four pins or screws. Radiographs that had been made at the time of presentation, before and after the operation, and at consecutive follow-up examinations were reviewed. Osteonecrosis was defined retrospectively on the basis of radiographic evidence of sclerosis and collapse of the femoral head. The risk of development of osteonecrosis was correlated with various clinical and radiographic parameters. RESULTS: All twenty-one patients in whom osteonecrosis developed had presented with an unstable slipped capital femoral epiphysis. None of the 204 patients who had presented with a stable slipped capital femoral epiphysis, regardless of grade, had development of osteonecrosis. In the group of patients who had presented with an unstable slipped capital femoral epiphysis, the risk of development of osteonecrosis increased with the severity (grade) of the slip. Osteonecrosis was more likely to develop in patients who had been treated with multiple pins than in those who had been treated with a single cannulated screw. CONCLUSIONS: Patients who have a stable slipped capital femoral epiphysis are not at risk for the development of osteonecrosis when treated with pinning in situ. Patients who have an unstable slipped capital femoral epiphysis have a decreased risk of osteonecrosis when treated with pinning in situ. Complete or partial reduction of an unstable slipped capital femoral epiphysis increases the risk of development of osteonecrosis. Pinning in situ without reduction with a single cannulated screw is the method of choice for the treatment of a slipped capital femoral epiphysis.     

髋前侧小切口植骨及内固定治疗中老年股骨颈骨折

目的探讨髋前侧小切口自体髂骨植骨及空心钉内固定治疗中老年移位型股骨颈骨折的疗效是否优于单纯空心钉内固定术。方法回顾分析2006年1月一2011年5月在我院治疗并获得随访的49例中老年移位型股骨颈骨折的临床资料,其中26例行单纯空心钉内固定术（对照组）,23例行髋前侧小切口自体髂骨植骨及空心钉内固定术（植骨组）,比较2组围术期情况和疗效。结果与对照组相比,植骨组手术时间长[（53．5±12．7）minVS．（40．4±9．7）min,t=4．084,P=0．000],术中出血量多[（66．1±22．7）mlvs．（46．4±13．8）ml,t=-3．719,P=0．000],术后住院时间无统计学差异[（7．1±2．9）dV8．（6．2±3．6）d,t=-0．955,P=0．344],但术后骨折愈合率高[100．0％（23／23）VS．76．9％（20／26）,P=0．016],股骨头缺血性坏死率低[8．7％（2／23）VS．34．6％（9／26）,X2=4．710,P=0．030]。49例随访12～48个月,平均25个月。根据髋关节功能Harris评分标准,植骨组术后评分显著高于对照组[（85．7±4．3）分vs．（79．1±6．2）分,t=-4．274,P=0．000]。结论髋前侧小切口自体髂骨植骨及空心钉内固定治疗中老年移位型股骨颈骨折,骨折愈合率高,股骨头缺血性坏死率较低,对中老年股骨颈骨折治疗具有积极意义。     

应用空心螺钉治疗老年股骨颈骨折的疗效

目的观察空心螺钉内固定治疗65岁以上老年股骨颈骨折的疗效。 方法前瞻性收集2012年3月至2017年5月符合纳入排除标准的65岁以上老年股骨颈骨折患者25例,作为观察组,同时选取21例65岁以下股骨颈骨折患者作为对照组,两组均采用闭合复位空心螺钉内固定,比较分析两组间的疗效差异。 结果两组随访时间12~36个月,平均（22±7）个月。观察组25例中获随访23例,骨折不愈合1例,股骨头缺血坏死2例;对照组21例中均获随访,骨折不愈合1例,股骨头缺血坏死1例,差异无统计学意义。术后1年髋关节Harris评分观察组平均为（78±11）分,对照组平均为（82±9）分,两组差异无统计学意义。 结论应用空心螺钉内固定治疗老年股骨颈骨折仍可获得低年龄组股骨颈骨折一样的治疗效果。