老年人移位股骨颈骨折内固定术中对股骨头血供观察的临床意义

目的 探讨老年移位股骨颈骨折术中对股骨头血供肉眼观察的临床意义.方法 2007年2月-2012年9月,对96例移位股骨颈骨折患者,年龄60～85岁,作髋关节前方和外侧双切口,在直视下将骨折解剖复位,以空心螺钉内固定,同时利用克氏针在股骨头上复位时留下的钻孔,观察孔内的渗血情况,了解股骨头真实的血液供应.并随访治疗结果.结果 所观察到的股骨头渗血情况：65岁以下年龄组和65岁及以上年龄组之间差异无统计学意义（P=0.376）.受伤至手术时间2～7d组与7d以上组之间差异有统计学意义（P=0.000）.不同骨折类型组之间差异没有统计学意义（P=0.294）.有或无股骨头缺血性坏死组之间差异有统计学意义（P=0.000）.结论 使用髋关节前方和外侧双切口将骨折解剖复位,以三枚空心螺钉内固定治疗老年人移位股骨颈骨折术中对股骨头血供的直接肉眼观察有临床意义.观察结果支持对股骨颈骨折早期手术的观点,加深了骨折移位对股骨头血液供应影响程度的认识,有利于评估术后的预后.对65岁及以上的有移位股骨颈骨折患者的治疗方案,仍然可以在人工髋关节置换和切开解剖复位内固定两者之间选择.

The clinical significance for intraoperative observation of femoral head blood supply during the displaced femoral neck fractures in the elderly

Objective To evaluate the clinical significance of intraoperative observation of femoral head blood supply by naked eye during displaced femoral neck fractures fixation in the elderly. Method From February 2007 to September 2012, 96 cases with displaced femoral neck fracture, aged 60 to 85 years old, received the both anterior and lateral approach tbr direct vision anatomic reduction and fixation with the hollow screws under fluroscopy. The operative results for patients were followed up. From the drilling holes on the femoral head when removed Kirschner wire for anatomic reduction, oozing was observed to determine the real blood supply of the femoral head. Results The observed femoral bleeding situations： There was no statistic difference （P=0.376） between the groups more or less than 65 years was observed. The significant difference （P=0.000） between the groups within a period of 2 to 7 days or more than 7 days from injury to surgery. Comp aring the groups of different fracture types no statistically significant difference was obtained （P=0.294）, but between the presence and absence of avascular necrosis of femoral head, the significant difference was demonstrated （P=0.000）. Conclusion There was clinical significance to observe the blood supply of femoral head directly by naked eye during the op- eration of anatomic reduction and internal fixation with the three hollow screws in elderly patients with displaced fracture of femoral neck. The operation had been done through both incision of front and lateral hip. The result of observations support the viewpoint that the operation for femoral neck fracture should be done early, deepened to understand the affect on blood supply of femoral head caused by displacement of fracture, helped to evaluate the prognosis after surgery. Both arthroplasty or internal fixation for patients older than 65 years old with displaced femoral neck fracture are recommated.