背景：一般认为股骨颈骨折内固定后股骨颈短缩2 cm 以上才会出现功能影响，但近年来许多文献认为短缩5 mm 以上就会出现功能和生活影响，争议颇多。目的：调查闭合复位空心钉置入内固定治疗股骨颈骨折后股骨颈短缩的发生率、功能影响及其相关影响因素。方法：对2003年5月至2011年1月收治的94例闭合复位空心钉置入内固定的股骨颈骨折患者进行回顾性分析，去除发生骨折不愈合和股骨头坏死患者后有86例患者进入结果分析。闭合复位满意后，以3枚平行空心钉固定。以短缩≥5 mm，短缩≥10 mm，短缩≥20 mm 为3个参考点，考察短缩(双侧股骨颈中心线对比)发生情况，以及多个因素对股骨颈短缩发生的影响。结果与结论：86例患者股骨颈短缩中位数2.6 mm，平均(5.21±5.49) mm。股骨颈短缩≥5 mm 的发生率为36%(31/86)，股骨颈≥10 mm 的发生率为19%(16/86)，股骨颈短缩≥20 mm 的发生率为3%(3/86)。3种短缩形式分组结果的 Harris 评分结果差异均有显著性意义，说明短缩≥5 mm 就会影响髋关节功能。性别、年龄、singh 指数、Garden 指数、体质量指数是影响股骨颈骨折内固定后股骨颈短缩的因素。提示股骨颈骨折闭合复位空心钉置入内固定后股骨颈短缩发生率较高，股骨颈短缩≥5 mm 就会对患者髋关节功能有影响。%BACKGROUND: General y, 2 cm shortening of the femoral neck may influence the function of hip joint. But in recent years, many literatures demonstrate that 5 mm shortening of the femoral neck may impact the function and the life quality, and there are a lot of controversies. OBJECTIVE: To investigate the incidence, functional impact and related factors of femoral neck shortening after the treatment of femoral neck fractures with closed reduction and cannulated screw fixation. METHODS: Ninety-four patients with femoral neck fractures admitted during May 2003 to January 2011, who were treated with closed reduction and cannulated screws fixation, were selected for the retrospective analysis. The patients with fracture nonunion and femoral head necrosis were excluded and final y 86 patients were included for the analysis. Femoral neck fractures were fixed with three cannulated screws after satisfactory closed reduction. The shortening length ≥ 5 mm, ≥ 10 mm and ≥ 20 mm were considered as three reference points to investigate the incidence of shortening (by comparing bilateral femoral neck centerline), as wel as the effect of several factors on femoral neck shortening. RESULTS AND CONCLUSION: The median of femoral neck shortening in 86 patients was 2.6 mm and averaged in (5.21±5.49) mm, including 36% (31/86) for shortening ≥ 5 mm, 19% (16/86) for shortening ≥10 mm and 3% (3/86) for shortening ≥ 20 mm. There was significant difference in Harris scores among three shortening groups, indicating that shortening ≥ 5 mm could influence the function of hip joint. Gender, age, singh index, Garden index and body mass index were the factors that affected the femoral neck shortening after fixation of femoral neck fractures. The results suggested that the incidence of femoral neck shortening is higher after closed reduction and cannulated screw fixation for femoral neck fractures, and the femoral neck shortening≥ 5 mm could impact the function of hip joint.
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