目的 比较3种不同方法治疗青壮年移位股骨颈骨折的疗效.方法 湖北省十堰市太和医院2013年1月-2015年1月收治移位的股骨颈骨折105例,其中切开复位3枚空心钉固定联合带血管蒂大转子骨瓣移位治疗35例(A组),Garden分型:Ⅲ型19例,Ⅳ型16例;切开复位3枚空心钉固定联合股方肌骨瓣移位治疗35例(B组),Garden分型:Ⅲ型18例,Ⅳ型17例;单纯闭合复位3枚空心钉固定治疗股骨颈骨折35例(C组),Garden分型:Ⅲ型19例,Ⅳ型16例.观察3组患者骨折愈合时间、术后1年患髋关节Harris评分、骨折不愈合及股骨头坏死情况.结果 3组病例随访24~48个月,平均35个月.A、B、C组骨折愈合时间分别为(82.0 ±17.6)d、(97.0 ±15.3)d、(109.0 ±14.5)d;术后1年患髋关节Harris评分分别为(87.5 ±3.6)分、(86.3 ±4.8)分、(86.1 ±3.5)分;骨折不愈合例数分别为1例(2.9%)、3例(8.6%)、5例(14.3%);股骨头坏死例数分别为2例(5.7%)、5例(14.3%)、7例(20.0%).在骨折愈合时间、骨折不愈合率和股骨头坏死率方面,A组与B、C组之间,差异均有统计学意义(P<0.05).在术后1年患髋关节Harris评分方面,A组与B、C组之间,差异均无统计学意义(P>0.05).结论 应用切开复位3枚空心钉固定联合带血管蒂大转子骨瓣移位治疗青壮年移位股骨颈骨折能显著降低骨折不愈合以及股骨头坏死发生率.%Objective To compare three different methods in treating displaced femoral neck fracture in young adults.Methods From Jan.2013 to Jan.2015,totally 105 cases of displaced femoral neck fracture were treated in our hospital.In group A,35 cases were treated with open reduction and 3 cannulated screws fixation,cov-ered by the vascularized greater trochanter bone flap.According to Garden classification,19 cases were type Ⅲand 16 cases were type IV.In group B,35 cases were treated with open reduction and 3 cannulated screws fixation,cov-ered by the quadratus femoris muscle pedicle bone flap.According to Garden classification:18 cases were type Ⅲand 17 cases were type IV.In group C,35 cases were treated with closed reduction and three cannulated screws fix-ation.According to Garden classification,19 cases were type Ⅲ and 16 cases were type IV.The healing time of fracture,Harris scoring of hip joint one year after surgery,nonunion fracture,and femoral head necrosis among three groups were observed.Results Three groups were followed up for 24-48 months,averagely 35 months.The healing time of group A was(82.0 ±17.6)days,Harris score of hip joint one year after surgery was(87.5 ±3.6)points, including 1 case of nonunion(2.9%)and 2 cases of femoral head necrosis(5.7%).The healing time of group B was(97.0 ±15.3)days,Harris score of hip joint one year after surgery was(86.3 ±4.8)points,including 3 cases of nonunion(8.6%)and 5 cases of femoral head necrosis(14.3%).The healing time of group C was(109.0 ± 14.5)days,Harris score of hip joint one year after surgery was(86.1 ±3.5)points,including 5 cases of nonunion (14.3%)and 7 cases of femoral head necrosis(20.0%).There were significant differences in the healing time of fracture,the rate of nonunion,and the rate of femoral head necrosis among the three groups(P<0.05).There was no significant difference in Harris score of hip joint one year after surgery among the three groups(P>0.05). Conclusion The treatment of open reduction with 3 cannulated screws,covered by the vascularized greater trochanter bone flap in young adults can remarkably reduce the incidence of nonunion and osteonecrosis of the femoral head.
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