【作者】 李海峰；

【导师】 赵长福；

【作者基本信息】 吉林大学 ， 临床医学， 2013， 硕士

【摘要】 目的：探讨前侧小切口与传统外侧切口入路空心拉力螺钉内固定术治疗股骨颈骨治疗效果，为股骨颈骨折内固定手术入路的选择及以后的研究提供依据。方法：回顾性研究2010年10月至2012年11月期间，吉林大学中日联谊医院骨科创伤学组诊治的股骨颈骨折患者经筛选后得到178例。入选的标准：收集病例中术中闭合复位失败，选择行前侧小切口及传统外侧切开复位空心钉内固定术41例。其中男性24例，女性17例。年龄16—63周岁，平均年龄48.5岁。外伤原因：交通事故22例，跌倒15例，高处坠落伤4例。其中GardenⅡ型2例，GardenⅢ型29例，及GardenⅣ10例。头下型9例、经颈型27例，基底型5例。内收型23例。中间型7例，外展型11例。将41例患者按手入路分为A、B两组，A组外侧入路：采取传统外侧切口（Wason-Jones入路的一部分）25例；B组前侧小切口入路：采取前侧小切口（为Smith-Peterson切口的一部分）16例。平均随访18个月（最短6个月，最长30个月）。所有骨折均为新鲜骨折,受伤到手术时间1-7天。统计学方法:应用SPSS13.0（IBM公司，美国）统计学软件包进行数据处理，计量资料用均数加减标准（X±S）表示，计量资料比较采用方差分析，P＜0.05差异有统计学意义。结果：B组较A组手术时间短，术中出血量少。B组较A组在股骨颈不愈合、股骨头坏死并发症无差异。A组与B组住院时间差异及三组患者间的Harris评分（行走评分、活动度评分）差异均无统计学意义。Garden指数与股骨颈骨折愈合率密切相关。结论：前方小切口入路治疗经闭合复位失败的新鲜股骨颈骨折，较传统外侧切口入路能减少手术时间、降低出血量。更多还原

【Abstract】 Objective:To study the treatment effect of open reduction and hollow tensionscrew internal fixation treated the fracture of femoral neck by smallanterior incision approach and traditional lateral approach.To selection ofsurgical approach for femoral neck fracture internal fixation andprovide a basis for the later research.Methods:Retrospective study the result of treatment which178patients withfemoral neck fracture caused by trauma during october2010to november2012. Selection criteria:41cases which closed reduction failure thenopen reduction and hollow tension screw internal fixation treated thefracture of femoral neck by small anterior incision approach andtraditional lateral approach. In41patients male24cases consist offemale17cases, The average age of48.5years old,ranging in age from21to58years, The femoral neck fracture resulted from amotor vehicle22cases,Fall down17,Falling injury from a high position4cases.TheGarden Ⅱ type in2cases, Garden type Ⅲ29cases, and Garden Ⅳ10cases.Head type9cases, jugular type27cases, basal type5cases.adduction type23cases. The middle type7cases, outreach in11cases. put41patients hands into the can be divided into A, B two groupsby approach.Group A:25cases adopts the traditional lateral incision (thepart of Wason-Jones approach).Group B:16cases adopts the front ofsmall incision (part of the Smith-Peterson approach). average follow-upof18months (minimum6months, the longest30months). All cases are fresh fracture.The operations were performed between1and7days afterinjury.Statistics:Statistical software package for data processing using SPSS13.0(IBM,the USA).Measurement data is reported as means±SD. Comparisonswere made between different treatment groups and determined byANOVA, A value of P <0.05was considered significant.Results:Group B compared with group A shorter operation time,intraoperative blood loss less.Group B than in group A femoral neck nohealing complications, femoral head necrosis, no difference.Group A andgroup B in hospital time difference and the Harris score between threegroups of patients (walk score, activity score) difference had no statisticalsignificance.Garden index is closely related to the rate of fracture healing.Conclusions:The displaced femoral neck fractueres treated by the anteriorincision does not lower the incidence of the osteonecrosis of femoral headand nonunion, but the anterior incision can obviously decrease thesurgical trauma, surgical time, surgical bleed. However, the anteriorincision posses the advantage of less trauma, less perioperative bleedingand rapid recovery.更多还原