【摘要】 目的比较前外侧入路和外侧入路切开复位内固定治疗移位股骨颈骨折的临床疗效。方法采用切开复位内固定治疗91例成人股骨颈骨折,其中采用髋关节前外侧小切口切开复位、经皮3枚空心钉内固定治疗55例(A组),采用髋关节外侧入路切开复位、3枚空心钉内固定治疗36例(B组)。结果 91例均获随访23~76个月,平均45个月。B组平均切口长度、手术时间、术中出血量大于A组,差异有统计学意义(P<0.05)。A组骨折达到Garden指数Ⅰ、Ⅱ、Ⅲ和Ⅳ级复位固定分别为39、13、3例,B组骨折达到Garden指数Ⅰ、Ⅱ、Ⅲ和Ⅳ级复位固定分别为13、15、8例,A组复位质量优于B组,差异有统计学意义(P<0.05)。A组3例骨折不愈合,B组5例骨折不愈合,A、B两组骨折不愈合率差异无统计学意义(P>0.05)。A组5例发生股骨头坏死,B组9例发生股骨头坏死,A组股骨头坏死发生率低于B组,差异有统计学意义(P<0.05)。结论对移位的股骨颈骨折行切开复位内固定,前外侧小切口较外侧切口创伤更小、复位更理想,手术并发症较少,是一种理想的微创手术方法。更多还原

【Abstract】 Objective To compare the outcomes of anterolateral and lateral approach in open reduction and cannulated compression screw fixation for displaced femoral neck fractures.Methods A total of 91 patients with femoral neck fractures were treated with open reduction and fixation,55 cases of them were operated through a limited anterolateral approach and with three cannulated compression screw percutaneous fixation(group A),36 cases were treated with lateral approach(group B).Results All patients received follow-up for 23~76 months,with an average of 45 months.Group B had significantly longer operation time,larger perioperative blood loss and average incision length than group A(P <0.05).The reduction of group A was rated as GardenⅠin 39 cases,GardenⅡin 13 cases,Garden Ⅲ and Ⅳ in 3 cases.Group B was GardenⅠ in 13 cases,Garden Ⅱ in 15 cases,Garden Ⅲ and Ⅳ in 8 cases(P <0.05).Nonunion was 3 cases in group A,5 cases in group B(P >0.05).Femoral avascular necrosis was 5 cases in group A,9 cases in group B(P <0.05).Conclusion Open reduction with anterior-lateral approach can achieve easily anatomical reduction.It is a good minimally invasive way for displaced femoral neck fractures with less trauma and complications compared with lateral approach.更多还原