联合股方肌蒂骨瓣移植治疗中青年囊内型股骨颈骨折临床分析
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摘要
目的对比空心钉内固定联合股方肌蒂骨瓣移植术与单纯空心钉固定两种手术方式,在治疗中青年囊内型股骨颈骨折时的术前准备时间、手术时间、复位质量Garden对线指数、骨折的愈合率、股骨头坏死率及髋关节功能Harris评分。讨论空心钉内固定联合股方肌蒂骨瓣移植术在预防中青年囊内型股骨颈骨折导致的股骨头坏死方面的优势及其作用机理,为临床提供理论依据。
资料与方法回顾性分析了湖北省中医院2001.3～2 007.5间收治的中青年囊内型股骨颈骨折55例,按手术方式分为空心钉内固定联合股方肌蒂骨瓣移植术与单纯空心钉固定两组。两组间的性别、年龄及Garden分型、骨折部位分型经过统计学检验差异无显著性意义,具备可比性。术后随访7月～7年,平均3.6年。二者比较项目包括术前准备时间、手术时间、复位质量Garden对线指数、骨折愈合率、股骨头坏死率、髋关节功能Harris评分。
1按照患者治疗股骨颈骨折手术方法将55例患者分为空心钉内固定联合股方肌蒂骨瓣移植术与单纯空心钉固定方式进行对比。
2对两组患者进行疗效比较,比较项目包括术前准备时间、手术时间、复位质量Garden对线指数、骨折愈合率、股骨头坏死率、髋关节功能Harris评分。
3对其进行列表对比,用SPSS13.0统计软件进行统计学处理。
结果
1术前准备时间联合术式组术前准备时间平均为3.16天,单纯空心钉固定组术前准备时间平均为6.64天,比较用t检验,差异有显著性意义(P＜0.05)。联合术式组术前准备时间短于单纯空心钉固定组。
2手术时间联合术式组手术时间平均为1.72小时,单纯空心钉固定组手术时间平均为0.86小时,比较用t检验,差异有显著性意义(P＜0.05)。联合术式组手术时间长于单纯空心钉固定组。
3复位质量Garden对线指数联合术式组GardenⅠ者23例,GardenⅡ者5例,GardenⅢ者2例;单纯空心钉固定组达到GardenⅠ者9例,GardenⅡ者8例,gardenⅢ者8例。比较用X~2检验,差异有显著性意义,联合术式组复位质量高于单纯空心钉固定组。
4两组骨折愈合率比较联合术式组骨折愈合29例,愈合率96.7%;单纯空心钉固定组骨折愈合数18例,愈合率72%。经X~2检验,差异有显著性意义,联合术式组骨折愈合率高于单纯空心钉固定组。
5两组股骨头坏死率比较联合术式组股骨头坏死2例,其中1例不愈合,坏死率6.7%;单纯空心钉固定组股骨头坏死8例,其中7例不愈合,坏死率32%。经X~2检验,差异有显著性意义,联合术式组股骨头坏死率低于单纯空心钉固定组。
6两组髋关节功能Harris评分依据Harris评分标准,从疼痛程度关节功能及关节活动度3方面评定,90分以上为优;80-89分为良;60-79分为中;60分以下为差。联合术式组优18例,良10例,可1例,差1例,优良率93.3%;单纯空心钉固定组优9例,良8例,可5例,差3例,优良率68%。经X~2检验,差异有显著性意义,联合术式组髋关节功能优于单纯空心钉固定组。
结论对于中青年囊内型股骨颈骨折患者,由于术前准备时间、术中复位质量及肌蒂骨瓣移植的原因,选择空心钉内固定加股方肌蒂骨瓣移植术疗效好于单纯空心钉固定组。
Objective The two ways of operation which are hollow screw internal fixations united with muscle bone flap of quadratus graft(it was called union operation for short)and simple hollow screw internal fixations were compared in the treatment of young and middle-aged intracapsular femoral neck fracture,and the items of comparison include the time of preparation and operation,the quality of reduction,the rate of union,the rate of necrosis of the femoral head and hip function Harris score.The superiority and mechanism of muscle bone flap of quadratus graft was discussed in preventing necrosis of the femoral head caused by intracapsular femoral neck fractures in the young and middle-aged,which provide a theoretical basis for the clinical.
Methods Retrospective analysises of the 55 cases which were intracapsular fractures of femoral neck in young and middle-aged from 2001.3 to 2007.5 in the Hubei TCM hospital in Hubei Province,according the difference of operative way,the cases were divided into two group: hollow screw fixation united with muscle pedicle bone graft and simple hollow screw internal fixation.The difference of sex,age,typing of Garden and fracture location was not marked significance as a result of statistics test and had comparability.Follow-up after operation last from 7 months to 7 years,an average of 3.6 years.The items of comparison include the time of preparation and operation、the quality of reduction、the rate of union、the rate of necrosis of the femoral head and hip function Harris score.
1 According the ways of treatment,the patients were classified into two groups.The one is hollow screw internal fixations united with muscle bone flap of quadratus graft,the other one is simple hollow screw internal fixations.
2 Comparing the clinical result of them,the items of comparison include the time of preparation and operation,the quality of reduction, the rate of union,the rate of necrosis of the femoral head,hip function Harris score.
3 Comparing result by list,treat it by SPSS13.0 statistical software.
Results
1 The time of preparation The average time of preparation of union operation group is 3.16 days;the average time of simple hollow screw internal fixations group is 6.64 days.The difference between them is significance compared with t-test.The time of preparation of union operation group is shorter than simply hollow screw internal fixations group.
2 The operative time The average operative time of union operation group is 1.72 hours;the average operative time of simple hollow screw internal fixations is 0.68 hours.The difference between them is significance compared with t-test.The average operative time of union operation group is longer.
3 The quality of reduction(Garden alignment index)Out of union operation group,23 cases reach Garden 1,5 cases reach GardenⅡ,2 cases reach GardenⅢ;out of simple hollow screw internal fixations,9 cases reach Garden 1,8 cases reach GardenⅡ,8 cases reach GardenⅢ.The difference between them is significance treated by x~2 test,the quality of reduction of union operation group is higher than the simple hollow screw internal fixations group.
4 The comparison of rate of union between the two groups The rate of union of union operation group is 96.7%,the rate of union of simple hollow screw internal fixations group is 72%,the difference between them is significance treated by x~2 test,the rate of union of union operation group is more.
5 The comparison of the rate of necrosis of the femoral head between the two groups The rate of necrosis of the femoral head of union operation group is 6.7%,the rate of necrosis of the femoral head of simple hollow screw internal fixations group is 32%,the difference between them is significance treated by x~2 test,the rate of necrosis of the femoral head of union operation group is less.
6 Comparison of the score of Harris between the two groups The good rate of the score of Harris of union operation group is 93.3%,the good rate of simple hollow screw internal fixations group is 68%The difference between them is significance treated by x~2 test,the score of Harris of union operation group is higher.
Conclusion It' sbetter for intracapsular fractures of femoral neck in young and middle-aged to choose hollow screw internal fixations united with muscle bone flap of quadratus graft than simple hollow screw internal fixations.
资料与方法回顾性分析了湖北省中医院2001.3～2 007.5间收治的中青年囊内型股骨颈骨折55例,按手术方式分为空心钉内固定联合股方肌蒂骨瓣移植术与单纯空心钉固定两组。两组间的性别、年龄及Garden分型、骨折部位分型经过统计学检验差异无显著性意义,具备可比性。术后随访7月～7年,平均3.6年。二者比较项目包括术前准备时间、手术时间、复位质量Garden对线指数、骨折愈合率、股骨头坏死率、髋关节功能Harris评分。
1按照患者治疗股骨颈骨折手术方法将55例患者分为空心钉内固定联合股方肌蒂骨瓣移植术与单纯空心钉固定方式进行对比。
2对两组患者进行疗效比较,比较项目包括术前准备时间、手术时间、复位质量Garden对线指数、骨折愈合率、股骨头坏死率、髋关节功能Harris评分。
3对其进行列表对比,用SPSS13.0统计软件进行统计学处理。
结果
1术前准备时间联合术式组术前准备时间平均为3.16天,单纯空心钉固定组术前准备时间平均为6.64天,比较用t检验,差异有显著性意义(P＜0.05)。联合术式组术前准备时间短于单纯空心钉固定组。
2手术时间联合术式组手术时间平均为1.72小时,单纯空心钉固定组手术时间平均为0.86小时,比较用t检验,差异有显著性意义(P＜0.05)。联合术式组手术时间长于单纯空心钉固定组。
3复位质量Garden对线指数联合术式组GardenⅠ者23例,GardenⅡ者5例,GardenⅢ者2例;单纯空心钉固定组达到GardenⅠ者9例,GardenⅡ者8例,gardenⅢ者8例。比较用X~2检验,差异有显著性意义,联合术式组复位质量高于单纯空心钉固定组。
4两组骨折愈合率比较联合术式组骨折愈合29例,愈合率96.7%;单纯空心钉固定组骨折愈合数18例,愈合率72%。经X~2检验,差异有显著性意义,联合术式组骨折愈合率高于单纯空心钉固定组。
5两组股骨头坏死率比较联合术式组股骨头坏死2例,其中1例不愈合,坏死率6.7%;单纯空心钉固定组股骨头坏死8例,其中7例不愈合,坏死率32%。经X~2检验,差异有显著性意义,联合术式组股骨头坏死率低于单纯空心钉固定组。
6两组髋关节功能Harris评分依据Harris评分标准,从疼痛程度关节功能及关节活动度3方面评定,90分以上为优;80-89分为良;60-79分为中;60分以下为差。联合术式组优18例,良10例,可1例,差1例,优良率93.3%;单纯空心钉固定组优9例,良8例,可5例,差3例,优良率68%。经X~2检验,差异有显著性意义,联合术式组髋关节功能优于单纯空心钉固定组。
结论对于中青年囊内型股骨颈骨折患者,由于术前准备时间、术中复位质量及肌蒂骨瓣移植的原因,选择空心钉内固定加股方肌蒂骨瓣移植术疗效好于单纯空心钉固定组。
Objective The two ways of operation which are hollow screw internal fixations united with muscle bone flap of quadratus graft(it was called union operation for short)and simple hollow screw internal fixations were compared in the treatment of young and middle-aged intracapsular femoral neck fracture,and the items of comparison include the time of preparation and operation,the quality of reduction,the rate of union,the rate of necrosis of the femoral head and hip function Harris score.The superiority and mechanism of muscle bone flap of quadratus graft was discussed in preventing necrosis of the femoral head caused by intracapsular femoral neck fractures in the young and middle-aged,which provide a theoretical basis for the clinical.
Methods Retrospective analysises of the 55 cases which were intracapsular fractures of femoral neck in young and middle-aged from 2001.3 to 2007.5 in the Hubei TCM hospital in Hubei Province,according the difference of operative way,the cases were divided into two group: hollow screw fixation united with muscle pedicle bone graft and simple hollow screw internal fixation.The difference of sex,age,typing of Garden and fracture location was not marked significance as a result of statistics test and had comparability.Follow-up after operation last from 7 months to 7 years,an average of 3.6 years.The items of comparison include the time of preparation and operation、the quality of reduction、the rate of union、the rate of necrosis of the femoral head and hip function Harris score.
1 According the ways of treatment,the patients were classified into two groups.The one is hollow screw internal fixations united with muscle bone flap of quadratus graft,the other one is simple hollow screw internal fixations.
2 Comparing the clinical result of them,the items of comparison include the time of preparation and operation,the quality of reduction, the rate of union,the rate of necrosis of the femoral head,hip function Harris score.
3 Comparing result by list,treat it by SPSS13.0 statistical software.
Results
1 The time of preparation The average time of preparation of union operation group is 3.16 days;the average time of simple hollow screw internal fixations group is 6.64 days.The difference between them is significance compared with t-test.The time of preparation of union operation group is shorter than simply hollow screw internal fixations group.
2 The operative time The average operative time of union operation group is 1.72 hours;the average operative time of simple hollow screw internal fixations is 0.68 hours.The difference between them is significance compared with t-test.The average operative time of union operation group is longer.
3 The quality of reduction(Garden alignment index)Out of union operation group,23 cases reach Garden 1,5 cases reach GardenⅡ,2 cases reach GardenⅢ;out of simple hollow screw internal fixations,9 cases reach Garden 1,8 cases reach GardenⅡ,8 cases reach GardenⅢ.The difference between them is significance treated by x~2 test,the quality of reduction of union operation group is higher than the simple hollow screw internal fixations group.
4 The comparison of rate of union between the two groups The rate of union of union operation group is 96.7%,the rate of union of simple hollow screw internal fixations group is 72%,the difference between them is significance treated by x~2 test,the rate of union of union operation group is more.
5 The comparison of the rate of necrosis of the femoral head between the two groups The rate of necrosis of the femoral head of union operation group is 6.7%,the rate of necrosis of the femoral head of simple hollow screw internal fixations group is 32%,the difference between them is significance treated by x~2 test,the rate of necrosis of the femoral head of union operation group is less.
6 Comparison of the score of Harris between the two groups The good rate of the score of Harris of union operation group is 93.3%,the good rate of simple hollow screw internal fixations group is 68%The difference between them is significance treated by x~2 test,the score of Harris of union operation group is higher.
Conclusion It' sbetter for intracapsular fractures of femoral neck in young and middle-aged to choose hollow screw internal fixations united with muscle bone flap of quadratus graft than simple hollow screw internal fixations.
引文
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