空心加压螺钉内固定治疗股骨颈骨折早期失败原因及处理分析

目的分析空心加压螺钉治疗股骨颈骨折早期失败的原因并提出预防措施。方法对20例空心加压螺钉治疗股骨颈骨折失败的病例进行失败原因分析和总结。其中采用切开复位动力髋螺钉(DHS)内固定5例,行旋髂深血管髂骨骨膜瓣移植5例,行人工关节置换10例。结果所有病例再次手术后均获得随访,随访时间12～24个月。DHS固定的患者中股骨颈骨折愈合10例,1例发生骨折不愈合行人工股骨头置换;行旋髂深血管髂骨骨膜瓣移植的患者骨折均愈合,随访2年未见股骨头坏死;10例关节置换患者功能恢复良好。结论股骨颈骨折内固定早期失败的原因包括髋钉在股骨头颈的位置不良、螺钉过短螺纹未完全通过骨折线、骨折对位不良、术后过早负重活动等。正确的手术操作、良好的骨折复位及规范康复指导是预防股骨颈骨折治疗失败的有效措施。

Analysis of failure reason at early period of collum femoris fracture treated with cannulated screw

Objective To analyze the failure reason at early period of collum femoris fracture treated with cannulated screw and to suggest the preventive measures.Methods Analyzed and summarized the failure reason of 20 cases patients with collum femoris fracture treated with cannulated screw.Among,5 cases were fixed with the DHS,5 cases were treated with grafting of iliac bone flap with deep iliac circumflex vessel,10 cases with prosthetic replacement.Results In all cases after the second operation were followed up for 12 to 24 months.DHS fixation of collum femoris fracture healing 10 cases,1 case of nonunion artificial femoral head replacement;Line iliac periosteal flap of the iliac vessels in patients with fractures healed,no 2-year follow-up of femoral head necrosis;Joint replacement in patients（10 cases） with good function.Conclusion The main failure reason of collum femoris fracture at early period includes that the hip nail is not located properly in the femoral neck and head,the thread of short implants is not cross the fracture line,unsatisfied reduction,and too early weight-bearing activities.Several measures can be adopted to prevent the failure,including proper internal fixation,satisfied reduction,appropriate and programmed postoperative management.