[青壮年股骨颈骨折的手术方法探讨与研究]股骨颈骨折坏死率
【摘要】目的 研究探讨治疗青壮年股骨颈骨折的最佳手术方法和临床疗效。 方法 对我院2005年1月至2010年12月的80例青壮年股骨颈骨折患者进行随访，从骨折的类型、手术时间选择、骨折复位质量、植入物的类型、术后卧床的时间和髋关节功能恢复等多个方面进行有效评估。 结果 80例患者均获得平均30个月的随访。73例(91.25％)患者在伤后2～4 d内行手术治疗，Garden Ⅱ、Ⅲ型骨折患者均行闭合复位钛合金窄心钉内固定术，GardenⅣ型及病理、陈旧性骨折患者行切开复位钛合金空心钉内固定加髂骨瓣植骨术。术中复位评价平均4.95分，术后平均4个月卧床时间。髋关节功能按照Harris评分标准：优39例，良30例，可9例，差2例，优良率86.25％。Garden Ⅱ、Ⅲ型骨折优良率较Ⅳ型骨折优良率高，但差异无统计学意义( χ2 =1.35， P =0.25)。 结论 影响青壮年股骨颈骨折手术治疗的关键因素是早期手术、解剖复位、多枚钛合金空心钉牢固内固定及GardenⅣ型骨折髂骨瓣植骨，合理进行术后早活动、晚负重是有效降低术后股骨头缺血坏死的重要保证。依据患者股骨颈骨折的损伤程度来量身制定最科学合理的治疗方案及术后康复策略，是提高青壮年股骨颈骨折临床疗效的重要前提。
【关键词】 青壮年；股骨颈骨折；手术方法；探讨与研究
Surgical methods of femoral neck fracture and research ZHAO Zhen-ying.Department of Traumatic Fracture,The People’s Hospital of Zhuhai City,Zhuhai 519000,China
【Abstract】 Objective To study the best surgical treatment of femoral neck fracture and clinical efficacy. Methods The type of hospital in 2005 from January to December 2010, 80 cases of femoral neck fracture patients were followed up, choose the type of fracture, operative time, fracture reduction and quality of the implants after bed time effective evaluation and hip joint function recovery. Results 80 patients have received an average of 30 months of follow-up. 73 cases (91.25%) patients after injury, 2～4 d expert surgical treatment, the Garden II, patients with type III fractures were closed reset titanium narrow heart nail fixation, Garden type Ⅳ and pathology, old fractures underwent open reduction and titanium cannulated screw fixation and bone grafting of the iliac bone. Reset intraoperative evaluation of an average of 4.95 points, average of 4 months after bed time. Hip function according to the Harris scores:excellent in 39 cases, good in 30 cases, may 9 cases and poor in 2 cases, good rate of 86.25%. Garden II, III fracture of the excellent rate of fracture than type Ⅳ good rate, but the difference was not statistically significant ( χ2 = 1.35, P = 0.25). Conclusion The key factors of femoral neck fracture surgery is early surgery, anatomic reduction, gold titanium alloy cannulated screw firmly fixed and Garden IV fractures of the iliac bone grafting, reasonable postoperative as early as activities, and late weight-bearing is effective reduce postoperative avascular necrosis of the guarantee. Tailored to develop the most scientific and rational treatment options and postoperative rehabilitation strategy based on the patients with femoral neck fracture damage process is an important prerequisite to improve the femoral neck fracture efficacy.