无移位股骨颈骨折的诊治误区及严格闭合复位内固定治疗的疗效观察

目的研究无移位股骨颈骨折的骨折特点并探寻更好的手术治疗方法。方法回顾性研究自2007-04—2010-03采用闭合复位内固定治疗且获得随访的58例无移位股骨颈骨折,其中GardenⅠ型41例,Ⅱ型17例。58例术前均行CT扫描明确其移位特点,并对其作分析,有针对性地采用严格闭合复位空心钉内固定治疗。术后对患者骨折愈合情况、术后并发症及患者功能恢复情况进行总结分析。结果 58例股骨颈骨折经CT扫描后分析发现,平均外翻角为（9.6±4.8）°,平均后倾角为（14.8±7.5）°;16例（27.6%）后倾角21°~32°,存在明显的骨折移位。本组均获得随访36~71个月,平均（50.8±9.4）个月,骨折全部愈合,未见内固定失效。1例股骨头坏死者行全髋关节置换术治疗。末次随访时髋关节功能：优29例,良22例,可6例,差1例,优良率87.9%。结论无移位股骨颈骨折（GardenⅠ、Ⅱ型）多存在一定程度的移位,要充分认识其特点,在选择内固定治疗前应常规行CT检查,而不能仅仅通过X线片判断。术中不能够原位内固定,而应该予以严格复位。

Misunderstanding of treatment of undisplaced femoral neck fractures and curative effect of fractures treated with rigidly closed reduction and internal fixation

Objective To study the characteristics of undisplaced femoral neck fractures and find a better treatment.Methods A retrospective study was conducted to evaluate outcomes of 58 patients treated with internal fixation for GardenⅠ（41 patients） and Ⅱ（17 patients） femoral neck fractures in our department between April 2007 and March 2010. The displaced angles were measured by CT scans, and rigidly closed reduction of fractures were made prior to internal fixation. The postoperative complications,fracture healing, incidence rate of avascular necrosis of the femoral head, failure of fixation and function al restoration of the patients were documented. Results The mean of valgus angles and posterior tilts were（9.6±4.8）° and（14.8±7.5）° respectively in 58 cases, and posterior tilts of 16 cases were 21°-32°. All cases were followed up for 36-71months,（50.8±9.4）months on average. Failure of fixation and nonunion was not found. Avascular necrosis of femoral head occurred in 1 case treated with total hip arthroplasty. The joint function was excellent in 29 cases, good in 22 cases, fair in 6cases, bad in 1 case, the excellent and good rate was 87.9%. Conclusion The displacement usually accompanies with GardenⅠ and Ⅱ femoral neck fractures and CT scans are indispensable. The rigidly closed reduction of fractures should be made prior to internal fixation.