克氏针辅助闭合复位治疗难复性股骨颈骨折

目的 探讨使用克氏针辅助闭合复位治疗难复性股骨颈骨折的可行性.方法 回顾性分析2008年6月至2011年4月治疗32例难复性股骨颈骨折患者资料,男15例,女17例；年龄21～59岁,平均46岁.根据Garden股骨颈骨折分型,Ⅱ型6例,Ⅲ型16例,Ⅳ型10例.根据患者术前X线及CT检查所示股骨头移位方向,将难复性股骨颈骨折分为:成角嵌插移位(11例)、旋转分离移位(15例)、外展嵌插移位(6例)三种类型.对于旋转分离和成角嵌插移位型骨折采用前方进针法,于股动脉外侧旁开1.5 cm处在X线透视下垂直向股骨头内锤入1～3枚直径3～3.5 mm的克氏针,进针深度约2～3 cm,克氏针向骨折移位的相反方向复位.外展嵌插移位型骨折采用侧方进针法,于大转子外侧向近端倾斜10°～15.锤入1～3枚3～3.5 mm直径的克氏针至股骨头内,向近端用力撬拨,使嵌插的骨折分离并复位,如仍不能复位,再于股骨干部垂直穿入1枚克氏针作为对抗针辅助骨折复位.复位满意后拧入空心钉固定.结果 32例难复性股骨颈骨折患者中,2例最终行切开复位内固定.30例经克氏针辅助闭合复位治疗患者骨折均达到或接近解剖复位.手术时间40～80 min,平均50 min；出血量20～50 ml,平均30 ml.术后Garden指数评价29例为解剖复位,1例为可接受复位.30例闭合复位患者中,29例获得随访,随访时间12～20个月,平均16个月.其中28例骨性愈合,愈合时间为4～10个月,平均时间为6个月；1例术前为旋转分离移位患者于术后15个月发生股骨头坏死,行人工全髋关节置换术治疗.结论 使用克氏针辅助闭合复位治疗难复性股骨颈骨折可获得满意的解剖复位率和骨折愈合率.

Closed reduction assisted with Kirschner wires for irreducible femoral neck fracture

Objective To investigate the feasibility of closed reduction assisted with Kirschner wires for irreducible femoral neck fracture. Methods From June 2008 to April 2011, 32 patients with irreducible femoral neck fracture were treated. There were 15 males and 17 females, aged from 21 to 59 years (average, 46 years). According to Garden classification, there were 6 of II, 16 of III and 10 of IV. According to displacement direction of the femoral head showed by preoperative X-rays and CT scans, irreducible femoral neck fracture was divided into 3 types: angulation-impaction (11 cases), rotation-separation (15 cases) and abduction-impaction (6 cases). One to three Kirschner wires were penetrated into the femoral head to reduce the displacement in opposite direction of fracture displacement. After reduction was satisfied, guide pins were penetrated, and then the fractures were fixed with cannulated screws. Results Anatomic or nearly anatomic reduction was achieved in 30 patients after closed reduction assisted with Kirschner wires. Two patients underwent open reduction finally due to failure of closed reduction. The operation time ranged from 40 to 80 min, and the blood loss ranged from 20 to 50 ml. According to Garden index, anatomic reduction was achieved in 29 and acceptable reduction in 1. Among 30 patients who had undergone closed reduction, 29 patients were followed up for 12 to 20 months. Bone union was achieved in 28 patients, and the fracture healing time ranged from 4 to 10 months. One patient with rotation-separation displacement before closed reduction underwent total hip replacement due to avascular necrosis of femoral head occurred at 15 months after closed reduction. Conclusion Closed reduction assisted with Kirschner wires is an effective method for irreducible femoral neck fracture, which can achieve satisfactory anatomic reduction rate and fracture healing rate.