Modified poking closed reduction for complex femoral neck fractures and choice of implant

doi:10.3969/j.issn.2095-4344.2014.22.004

Abstract

Abstract:

BACKGROUND: Femoral neck fracture was generally treated with closed reduction and internal fixation, but there are still some patients failing to get well with the conventional technique of closed reduction.

OBJECTIVE: To observe clinical therapeutic effects of modified poking closed reduction technique for complex femoral neck fractures.

METHODS: A total of 36 cases of complex femoral neck fracture were collected from the Department of Orthopedics, Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University in China from December 2011 to October 2013. After one or two failures of conventional technique for closed reduction, they were treated with modified poking closed reduction and hollow screw fixation. According to age, type of fracture and bone density, dynamic hip screw combined with one hollow screw (n=17) or three hollow screws (n=19) were used. After fixation, clinical efficacy was evaluated with the Harris Hip Score during follow-up.

RESULTS AND CONCLUSION: All 36 patients were followed up for 6 months to 2 years, with an average of 15.5 months. Osteonecrosis appeared in three cases and delayed fracture healing happened in two cases. Garden reset quality evaluation results were as follows: grade I in 23 cases, grade II in 11 cases, grade III in 2 cases, grade IV in 0 case; grade I and grade II accounted for 94.4% of the total number of patients. Harris Hip Score results were as follows: excellent in 22 cases, good in 7 cases, average in 3 cases, and poor in 4 cases, with an excellent and good rate of 80.56%. Harris scores were similar between patients receiving dynamic hip screw and one hollow screw or three hollow screws (P > 0.05). Therefore, our suggestion is that the patients with complex femoral neck fractures may try to be treated with modified poking closed reduction technique when conventional reduction technique failed. Dynamic hip screw or hollow screw did not obviously affect therapeutic outcomes.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: femoral neck fractures, fractures, bone, internal fixators, fractures, closed

CLC Number:

R318

Yang Fa-min. Modified poking closed reduction for complex femoral neck fractures and choice of implant[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(22): 3463-3468.

Figures/Tables 3

2.1 参与者数量分析及临床信息所有36例患者均同意参与本研究，并签署知情同意书，中途无退出，患者临床信息见表1。 2.2 随访情况所有改良的撬拨技术闭合复位复杂股骨颈骨折患者随访6个月-2年，平均15.5个月。内固定后无一例伤口感染或不愈合。无特殊情况时，内固定后4个月内，1.0-1.5个月复查一次X射线片，观察骨折愈合情况。内固定后4个月以上，患者有特殊不适时复查X射线片，或进一步进行CT和MRI检查。 36例复杂股骨颈骨折患者中在4个月时骨折愈合34例，2例骨折延迟愈合，分别于内固定后7个月和10个月愈合。3例患者分别在内固定后6，9，18个月出现股骨头坏死(表1)。 2.3 Garden复位质量评价在内固定后即刻拍摄正侧位X射线片进行Garden复位质量评价，其中Ⅰ级23例，Ⅱ级11例，Ⅲ级2例，Ⅳ级0例。Ⅰ级和Ⅱ级占患者总数的94.4%，Ⅲ级占患者总数的5.6%。2例Ⅲ级患者正位片显示股骨干内缘与股骨头内侧压力骨小梁夹角分别为156°和157°而侧位片显示股骨头轴线与股骨颈轴线夹角均>180°。 2.4 Harris髋关节评分内固定后6个月，患者Harris评分的疼痛得分(39.2±6.3)分，功能评分中，步态(28.1±4.0)分，日常功能评价(9.8±1.9)分，关节活动度(3.9±0.7)分，畸形(3.7±0.5)分，总共(84.8±11.8)分。按等级分，优22例，良7例，中3例，差4例，优良率80.56%(表2)。 2.5 植入物选择与疗效的关系采用动力髋螺钉加防旋空心螺钉或3枚空心螺钉进行内固定的患者的髋关节Harris评分接近(P > 0.05，表2)。动力髋螺钉内固定患者中13例动力髋螺钉角度为135°，4例为130°，1例发生股骨头坏死，1例发生骨折延迟愈合。3枚空心螺钉内固定患者中，2例发生股骨头坏死，1例发生骨折延迟愈合。 2.6 其他情况从损伤到手术需4-39 h，平均17 h；包括常规复位失败耗费的手术时间，其中手术需0.6-1.5 h，平均0.9 h；内固定中使用的克氏针或撬拨针1-4根，平均1.6根。 2.7 不良反应及并发症 3例患者发生股骨头坏死，均经二次手术，进行人工全髋关节置换，置换后无明显不良并发症发生。"

References

[1] Basso T, Klaksvik J, Syversen U, et al. Biomechanical femoral neck fracture experiments--a narrative review. Injury. 2012; 43(10):1633-1639.
[2] Souder CD, Brennan ML, Brennan KL, et al. The rate of contralateral proximal femoral fracture following closed reduction and percutaneous pinning compared with arthroplasty for the treatment of femoral neck fractures. J Bone Joint Surg Am. 2012;94(5):418-425.
[3] 陈跃平,高辉,陈亮,等.关节置换与植入物内固定治疗老年移位型股骨颈骨折的系统评价[J].中国组织工程研究,2012,16(9): 148-152.
[4] Støen RØ, Lofthus CM, Nordsletten L, et al. Randomized trial of hemiarthroplasty versus internal fixation for femoral neck fractures: no differences at 6 years. Clin Orthop Relat Res. 2014;472(1):360-367.
[5] von Friesendorff M, Besjakov J, Akesson K. Long-term survival and fracture risk after hip fracture: a 22-year follow-up in women. J Bone Miner Res. 2008;23(11):1832-1841.
[6] Gao H, Liu Z, Xing D, et al. Which is the best alternative for displaced femoral neck fractures in the elderly?: A meta-analysis. Clin Orthop Relat Res. 2012;470(6):1782- 1791.
[7] 艾自胜,张长青,刘粤,等.股骨颈骨折内固定术后随访资料的Harris评分分析[J].中国修复重建外科杂志,2009,23(4):57-61.
[8] Zuckerman JD. Hip fracture. N Engl J Med. 1996;334(23): 1519-1525.
[9] 李海峰,亓玉彬,李强,等.老年人股骨颈骨折手术治疗进展[J].中国老年学杂志,2013,33(3):231-233.
[10] 何振辉.股骨颈骨折经皮撬拨复位法[J].中国中医骨伤科, 1993, (3):39-41.
[11] 侯喜君,李霖,王春华,等.陶瓷对陶瓷全髋关节置换治疗中青年股骨颈骨折的分析[J].中国组织工程研究,2013,17(52):8955-8960.
[12] Karanicolas PJ, Bhandari M, Walter SD, et al. Interobserver reliability of classification systems to rate the quality of femoral neck fracture reduction. J Orthop Trauma. 2009; 23(6):408-412.
[13] Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51(4):737-755.
[14] Murphy DK, Randell T, Brennan KL, et al. Treatment and displacement affect the reoperation rate for femoral neck fracture. Clin Orthop Relat Res. 2013;471(8):2691-2702.
[15] 韦利红,徐良丰,单军标.克氏针撬拨辅助复位空心钉内固定治疗股骨颈骨折[J].中医正骨,2013,25(1):53-54.
[16] 倪增良,樊渊,唐海军,等.撬拨复位空心钉内固定治疗股骨颈骨折[J].中国骨伤,2009,22(9):70-71.
[17] Su Y, Chen W, Zhang Q, et al. An irreducible variant of femoral neck fracture: a minimally traumatic reduction technique. Injury. 2011;42(2):140-145.
[18] 刘明武.双针撬拨辅助复位加空心钉内固定治疗股骨颈骨折[J].湖北中医杂志,2011,33(7):75.
[19] 孙彦豹,王静,金宝城,等.闭合复位动力髋螺钉联合防旋螺钉内固定治疗PauwelsIII型股骨颈骨折[J].创伤外科杂志,2013,15(6): 513-515.