[1]刘明宇 程子文 姚双权** 任栋 耿林丹 康博洋 陈宇峰 王鹏程.CT三维重建引导下双平面克氏针撬拨辅助复位与切开复位治疗股骨颈骨折的疗效比较[J].中国微创外科杂志,2023,01(6):456-461.
　Liu Mingyu,Cheng Ziwen,Yao Shuangquan,et al.Comparison Between Dualplane Kirschner Wire Prying Assisted Reduction Guided by Threedimensional CT Reconstruction and Open Reduction in the Treatment of Femoral Neck Fracture[J].Chinese Journal of Minimally Invasive Surgery,2023,01(6):456-461.
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CT三维重建引导下双平面克氏针撬拨辅助复位与切开复位治疗股骨颈骨折的疗效比较()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2023年6期
页码:
456-461
栏目:
临床研究
出版日期:
2023-06-25

文章信息/Info

Title:
Comparison Between Dualplane Kirschner Wire Prying Assisted Reduction Guided by Threedimensional CT Reconstruction and Open Reduction in the Treatment of Femoral Neck Fracture
作者:
刘明宇 程子文 姚双权** 任栋 耿林丹 康博洋 陈宇峰 王鹏程
(河北医科大学第三医院创伤急救中心，石家庄050000)
Author(s):
Liu Mingyu;  Cheng Ziwen;  Yao Shuangquan;  et al.
Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang 050000, China
关键词:
股骨颈骨折; 克氏针; CT三维重建; 切开复位
Keywords:
Femoral neck fracture; Kirschner wire; Threedimensional CT reconstruction; Open reduction
文献标志码:
A
摘要:
目的比较CT三维重建引导下双平面克氏针撬拨辅助复位与有限切开复位治疗难复性股骨颈骨折的临床疗效。方法回顾性分析2019年1月～2021 年6月我院创伤急救中心采用CT三维重建引导下双平面克氏针撬拨辅助复位与有限切开复位治疗难复位性股骨颈骨折44例(Garden Ⅲ型 19例和Ⅳ型25例)，采用双平面克氏针撬拨辅助复位25例(撬拨复位组)，切开复位19例(切开复位组)，比较2组患者手术时间、术中出血量、术后复位质量、术后并发症情况。结果撬拨复位组手术时间(102.6±13.4)min，明显短于切开复位组(128.9±13.0)min(t=-6.546，P=0.000)；术中出血量(66.7±11.5)ml，明显少于切开复位组(103.6±12.4)ml(t=-10.185，P=0.000)。撬拨复位组复位质量Ⅰ级20例，Ⅱ级5例，切开复位组Ⅰ级16例，Ⅱ级3例，2组复位质量差异无统计学意义(Z=-0.355，P=0.723)。44例平均随访2.1年(1.5～2.5年)，骨折均愈合，撬拨复位组无术后并发症发生，切开复位组1例术后切口感染，1例随访1年后发生股骨头坏死。结论与切开复位相比，CT三维重建引导下双平面克氏针撬拨辅助复位治疗难复性股骨颈骨折，复位快捷，手术创伤小，是切开复位前值得尝试的方法。
Abstract:
ObjectiveTo compare the clinical effect between dualplane Kirschner wire prying assisted reduction guided by threedimensional CT reconstruction and limited open reduction in the treatment of refractory femoral neck fracture.MethodsFrom January 2019 to June 2021, 44 patients with refractory femoral neck fracture in our hospital were retrospectively analyzed. There were 19 cases of Garden type Ⅲ and 25 cases of Garden type Ⅳ. According to the intraoperative reduction method, the 44 cases were divided into prying reduction group (n=25) and open reduction group (n=19). The operation time, intraoperative bleeding volume, postoperative quality of reduction and postoperative complications were compared.ResultsThe operation time in the prying reduction group ［(102.6±13.4) min］ was significantly less than that in the open reduction group ［(128.9±13.0) min, t=-6546, P=0000］, and the intraoperative bleeding volume in the prying reduction group ［(66.7±11.5) ml］ was significantly less than that in the open reduction group ［(103.6±12.4) ml, t=-10.185, P=0.000］. In the prying reduction group, the reduction quality was gade Ⅰ in 20 cases and gade Ⅱ in 5 cases; in the open reduction group, there were 16 cases of grade Ⅰ and 3 cases of grade Ⅱ. The results showed no significant difference in reduction quality between the two groups (Z=-0.355, P=0723). All the 44 cases were followed up for an average of 2.1 years (range, 1.5-2.5 years). The fractures healed in all the 44 patients. No postoperative complications occurred in the prying reduction group. In the open reduction group, one patient had operative incision infection and one patient developed femoral head necrosis 1 year after surgery. ConclusionCompared to the limited open reduction, dualplane Kirschner wire prying assisted reduction for the treatment of refractory femoral neck fracture guided by threedimensional CT reconstruction has advantages of rapid reduction and less surgical trauma, which is worthy of trying before open reduction.

参考文献/References:

[1]周方.股骨颈骨折治疗的热点与创新.中华创伤骨科杂志,2021,23(9):742-747.
[2]Halvorson J. Reduction techniques for young femoral neck fractures. J Orthop Trauma,2019,33(Suppl 1):S12-S19.
[3]Yoon BH, Kim YS, Koo KH, et al. A simple percutaneous technique to reduce valgusimpacted femoral neck fractures. Clin Orthop Surg,2020,12(2):258-262.
[4]Noda M, Takahashi M, Nukuto K, et al. Innovative technique of minimally invasive closed reduction for impacted femoral neck fractures (MICRIF). J Orthop Surg,2019,27(1):1-4.
[5]Patterson JT, Ishii K, Tornetta P 3rd, et al. Open reduction is associated with greater hazard of early reoperation after internal fixation of displaced femoral neck fractures in adults 18-65 years. J Orthop Trauma,2020,34(6):294-301.
[6]中国医师协会骨科医师分会骨循环与骨坏死专业委员会，中华医学会骨科分会骨显微修复学组，国际骨循环学会中国区.中国成人股骨头坏死临床诊疗指南(2020).中华骨科杂志,2020,40(20):1365-1376.
[7]张健,汤欣.青壮年Pauwels Ⅲ型股骨颈骨折的内固定治疗进展.中华创伤骨科杂志,2021，23(6):502-506.
[8]Sanghavi S, Patwardhan S, Shyam A, et al. Nonunion in pediatric femoral neck fractures. J Bone Joint Surg Am,2020,102(11):1000-1010.
[9]张雅文,侯国进,周方，等.Pauwels Ⅲ型股骨颈骨折闭合复位内固定术后缺血性股骨头坏死的多因素分析.中国微创外科杂志,2020,20(12):1057-1062.
[10]Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. Orthop Trauma,2019,33(1):S1-S6.
[11]蔡跃波,唐迎春,李建赤,等.股骨颈骨折内固定术后前倾角变化对股骨近端力学影响的有限元分析.中国当代医药,2016, 23(1):107-109．
[12]王颖,马剑雄,柏豪豪,等.股骨颈骨折术后不同复位质量的力学特性分析.医用生物力学,2021,36(2):284-289.
[13]Keshet D, Bernstein M. Open reduction internal fixation of femoral neck fracture-Anterior approach. J Orthop Trauma,2020,34(2):S27-S28.
[14]禹宝庆,贾建波.青壮年股骨颈骨折的治疗策略.中华创伤骨科杂志,2021,23(8): 645-650.
[15]万安营,唐淼.直接前侧入路空心钉内固定治疗青壮年股骨颈骨折.中国矫形外科杂志,2019,27(18):1648-1652.
[16]任栋,程培焱,宋朝晖,等.不同数量和空间构型的空心拉力螺钉治疗股骨颈骨折的有限元分析.中华创伤杂志,2017,33(9)： 815-822.
[17]张浩,史雪峰,杨春宝,等.三枚与四枚螺钉置入治疗Pauwels Ⅲ型股骨颈骨折的有限元分析.中国组织工程研究,2016,20(26):3897-3902.
[18]孙彦豹,金宝城,王静,等.四枚空心钉菱形四壁支撑内固定股骨颈骨折.中国矫形外科杂志,2020,28(20):1857-1861.

备注/Memo

备注/Memo:
基金项目：河北医科大学第三医院2021年度老年病防治项目**通讯作者，Email：docshuang@126.com
更新日期/Last Update: 2023-09-07