Strategies of closed reduction in treatment of femoral neck fracture using cannulated screw fixation

目的: 探讨股骨颈骨折空心钉固定治疗过程中术中复位策略及复位优良率与术后疗效的关系。. METHODS: A retrospective analysis was made on the clinical data of 174 cases of femoral neck fracture treated between August 2005 and March 2015. There were 78 males and 96 females with an average age of 53.8 years (range, 23-75 years). The injury causes were falling in 85 cases, traffic accident in 61 cases, and falling from height in 28 cases. According to Garden typing, there were 35 cases of type I, 56 cases of type Ⅱ, 47 cases of type Ⅲ, and 36 cases of type Ⅳ. The time from injury to operation was 1-7 days (mean, 2.74 days). Based on reduction strategy, closed 3 hollow compression screws were used; evaluating standards for fracture reduction effect were also established. Harris score was used for effectiveness evaluation. 结果: 174 例患者均获随访，随访时间 12 ～ 42 个月，平均 36.5 个月。152 例患者骨折愈合，愈合时间为 6 ～ 12 个月，平均 9 个月。 9 例骨折不愈合及 3 例内固定失效者（术后 2 ～ 8 个月）?行人工半髋关节置换术； 6例于术后 15～ 26个月，平均 18.5个月取出内固定物后 6～ 12个月出现股骨头坏死，行全髋关节置换术； 4 例骨折不愈合行带血管蒂髂骨瓣移植术。均未出现内固定物切出等严重并发症。末次随访时， Garden Ⅰ～Ⅳ型复位标准优良率分别为 94.29%、 91.07%、 87.23%、 75.00%，综合优良率为 87.36%； Harris 评分优良率分别为 97.14%、78.57%、68.09% 和 50.00%，综合优良率为 73.56%。. 结论: 空心钉内固定治疗股骨颈骨折除应具有合理的植钉技术外，遵循正确良好的复位策略并进行复位效果评估可取得较好疗效，骨折复杂程度与复位优良率成反比，复杂骨折应尽量取得较高的复位优良率以达到后期良好预后。.