导针钝头探通法辅助判断空心拉力螺钉置入深度在老年人股骨颈骨折闭合复位内固定术中的应用

doi:10.3760/cma.j.cn101202-20211026-00303

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摘要目的探讨导针钝头探通法辅助判断空心拉力螺钉置入深度在老年患者股骨颈骨折闭合复位内固定术中应用的效果。方法回顾性研究。纳入2016年10月—2020年10月河北医科大学第三医院创伤急救老年骨科收治的老年股骨颈骨折患者16例,其中男3例、女13例,年龄65~89（70.1±4.8）岁。患者均为GardenⅡ型骨折。均行闭合复位空心拉力螺钉内固定手术治疗,术中均使用导针钝头探通法辅助判断空心拉力螺钉置入深度。术后即刻复查患侧髋关节CT及三维重建,观察骨折断端对位、对线情况,螺钉的置入位置,测量螺钉尖与股骨头软骨下骨的距离,评估导针钝头探通法辅助判断螺钉深度技术的效果及有效性。术后1年内定期随访,观察切口愈合情况、骨折愈合时间以及内固定断裂、骨折不愈合等并发症的发生情况。术后6个月采用Harris评分评定疗效。结果 16例患者均顺利完成手术治疗,手术时间为30~85（51.8±11.2） min,术中出血量为20~100（44.3±23.5） mL。16例患者共打入空心拉力螺钉49枚,术后即刻影像学检查显示,骨折断端对位、对线优良,螺钉的置入位置良好,螺钉钉尖与股骨头软骨下骨的距离为0.21~0.49 （0.38±0.11） cm;螺钉置入位置均有效,有效性为优（100%）。术后患者伤口均一期愈合,未发生感染、内固定失败。16例患者均获随访,随访时间6~16（9.1±3.3）个月。随访期间无螺钉断钉、退钉及股骨头塌陷、坏死等并发症发生,骨折愈合时间为3~6（4.1±1.0）个月。术后6个月采用Harris评分评定疗效,16例患者疗效均为优良。结论在老年股骨颈骨折闭合复位内固定术中,使用导针钝头探通法辅助判断空心拉力螺钉置入深度,可将螺钉尖准确放置在股骨头软骨下骨下方0.5 cm范围内,有助于提高内固定稳定性、促进骨折断端良好愈合。

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	杨旭庆
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	王庆贤

关键词 ：股骨颈骨折, 闭合复位, 空心拉力螺钉, 导针, 老年人

Abstract：Objective To determine the effect of the blunt head sounding of guide wire on the judgment of the depth of cannulated lag screw in the closed reduction and internal fixation of femoral neck fracture in the elderly. Methods A retrospective analysis was carried out on 16 elderly patients with femoral neck fracture admitted to the geriatric orthopedic trauma center of the Third Hospital of Hebei Medical University from October 2016 to October 2020. There were three males and 13 females in the age range of 65-89 (70.1±4.8) years old. The fractures were Garden type Ⅱ. The patients underwent closed reduction and internal fixation with cannulated lag screw. During the operation, the blunt end sounding of the guide wire was used to assist in judging the depth of the cannulated lag screw. CT and 3D reconstruction of hip joint on the affected side were reviewed immediately after the operation to observe the position and alignment of the broken end of the fracture and the the insertion position of screw. The distance between the cannulated lag screw tip and the subchondral bone of the femoral head was measured. The effect and effectiveness of using the blunt end sounding of the guide wire to assist in judging the depth of the screw were determined. Regular follow-up was conducted within 1 year after the operation to observe the wound healing, fracture healing time, breakage of internal fixation, and nonunion. The curative effect was evaluated by Harris score 6 months after the operation. Results Sixteen patients successfully underwent the operation. The operation time was 30-85 (51.8±11.2) min, and the amount of intraoperative bleeding was 20-100 (44.3±23.5) mL. A total of 49 cannulated lag screws were inserted into 16 patients. The CT and 3D reconstruction images of the hip joint on the affected side that were taken immediately after operation showed that the position and alignment of the broken end of the fracture were excellent, the insertion position of screw was good, the distance between the screw tip and the subchondral bone of the femoral head was 0.21-0.49 (0.38 ± 0.11) cm, the insertion position of the screw was effective, and the effectiveness (100%) was excellent. All wounds healed in one stage after the operation, and there was no infection and internal fixation failure. Sixteen patients were followed up for 6-16 (9.1±3.3) months. No complications, such as screw breakage, screw withdrawal, collapse, and necrosis of femoral head, were found during the follow-up period. The healing time of the fracture was 3-6 (4.1±1.0) months. The curative effect was evaluated by Harris score 6 months after the operation, and the therapeutic effects on 16 patients were excellent. Conclusion In the closed reduction and internal fixation of femoral neck fracture in the elderly, the technique of using the blunt head sounding of guide wire to assist in judging the depth of cannulated lag screw helps improve the stability of internal fixation and promoted fracture healing. The cannulated lag screw tip can be accurately located within 0.5 cm of the subchondral bone of the femoral head.

Key words： Femoral neck fracture Close reduction Cannulated lag screw Guide wire Aged

收稿日期: 2021-10-26

通讯作者: 王庆贤,Email：wqxwx1028@163.com

引用本文:

杨旭庆, 张宇乾, 张建永, 王庆贤. 导针钝头探通法辅助判断空心拉力螺钉置入深度在老年人股骨颈骨折闭合复位内固定术中的应用[J]. 中华解剖与临床杂志, 2022, 27(6): 391-395.
Yang Xuqing, Zhang Yuqian, Zhang Jianyong, Wang Qingxian. Application of guide wire blunt head assisted judgment of cannulated lag screw depth in closed reduction and internal fixation of femoral neck fracture in the elderly. Chinese Journal of Anatomy and Clinics, 2022, 27(6): 391-395.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20211026-00303 或 http://www.cjac.com.cn/CN/Y2022/V27/I6/391

[1]	张英泽. 临床创伤骨科流行病学[M]. 2版.北京:人民卫生出版社,2014: 178-179.
[2]	Kani KK, Porrino JA, Mulcahy H, et al.Fragility fractures of the proximal femur: review and update for radiologists[J]. Skeletal Radiol, 2019, 48(1): 29-45. DOI: 10.1007/s00256-018-3008-3.
[3]	柴斌, 李康养, 丁文彬, 等. 股骨颈骨折空心加压螺钉内固定术后股骨头坏死的原因分析[J].中国骨与关节损伤杂志,2017, 32(2):182-184. DOI:10.7531/j.issn.1672-9935.2017.02.021.
[4]	杨飞, 胡黎婷, 张兴胜. 三种术式治疗老年移位股骨颈骨折临床疗效对比研究[J].中国矫形外科杂志,2019,27(20):1850-1855. DOI: 10.3977/j.issn.1005-8478.2019.20.06.Yang F,Hu LT, Zhang XS.Comparison of three surgical procedures for displaced femoral neck fractures in elderly[J].Orthopedic Journal of China, 2019,27(20):1850-1855. DOI: 10.3977/j.issn.1005-8478.2019.20.06.
[5]	滕延斌, 李亭亭, 王磊, 等. 股骨颈骨折内固定术后骨折不愈合或畸形愈合的危险因素分析[J].中华创伤骨科杂志,2020,22(9): 799-803. DOI: 10.3760/cma.j.cn115530-20200428-00294.Teng YB, Li TT, Wang L, et al.Risk factors for nonunion or malunion after internal fixation of femoral neck fracture[J].Chin J Orthop Trauma,2020,22(9):799-803. DOI: 10.3760/cma.j.cn115530-20200428-00294.
[6]	冯声昌,吴凡,程俊, 等.空心加压螺钉治疗股骨颈骨折[J].中国骨与关节损伤杂志, 2009, 24(6):560-561. DOI:10.3969/j.issn.1673-9701.2007.19.036.
[7]	Ioannidis I, Mohammad Ismail A, Forssten MP, et al.Surgical management of displaced femoral neck fractures in patients with dementia: a comparison in mortality between hemiarthroplasty and pins/screws[J]. Eur J Trauma Emerg Surg, 2022, 48(2): 1151-1158. DOI: 10.1007/s00068-021-01640-0.
[8]	Bhandari M, Devereaux PJ, Tornetta P, et al.Operative management of displaced femoral neck fractures in elderly patients. An international survey[J]. J Bone Joint Surg Am, 2005, 87(9):2122-2130. DOI: 10.2106/JBJS.E.00535.
[9]	龙亚周, 张树明, 王奎友, 等. 空心加压螺钉内固定治疗老年股骨颈骨折[J].中国骨与关节损伤杂志,2015,30(10):1088-1089. DOI: 10.7531/j.issn.1672-9935.2015.10.025.
[10]	Nakanishi Y, Hiranaka T, Shirahama M, et al.Ideal screw positions for multiple screw fixation in femoral neck fractures-Study of proximal femur morphology in a Japanese population[J]. J Orthop Sci, 2018,23(3):521-524. DOI: 10.1016/j.jos.2018.01.012.
[11]	李波, 熊文峰, 张世民. 锁定钢板治疗肱骨近端骨折中螺钉穿透关节面的研究进展[J]. 中国修复重建外科杂志, 2021, 35(4): 403-408. DOI: 10.7507/1002-1892.202010099.Li B, Xiong WF, Zhang SM, Research progress on intra-articular screw penetration in proximal humeral fracture treated with locking plate[J].Chinese Journal of Reparative and Reconstructive Surgery,2021, 35(4): 403-408. DOI: 10.7507/1002-1892.202010099.
[12]	Bengard MJ, Gardner MJ.Screw depth sounding in proximal humerus fractures to avoid iatrogenic intra-articular penetration[J]. J Orthop Trauma, 2011,25(10):630-633. DOI: 10.1097/BOT.0b013e318206eb65.
[13]	危杰. 老年股骨颈骨折的治疗要点及注意事项[J].中华创伤骨科杂志, 2019, 21(9): 826-828. DOI: 10.3760/cma.j.issn.1671-7600.2019.09.016.Wei J.Essentials and precautions in treatment of femoral neck fracture in the elderly[J]. Chin J Orthop Trauma, 2019,21(9):826-828. DOI: 10.3760/cma.j.issn.1671-7600.2019.09.016.
[14]	Schottel PC, Blankstein M, Sprague S, et al.Optimal technical factors during operative management of low-energy femoral neck fractures[J]. J Orthop Trauma, 2021,35(2):92-99. DOI: 10.1097/BOT.0000000000001891.
[15]	Guo J, Dong W, Yin Y, et al.The effect of configuration of rhombic cannulated screws on internal fixation of femoral neck fractures[J]. Orthopedics, 2020,43(2):e72-e78. DOI: 10.3928/01477447-20191212-03.
[16]	吴贵佑,于前进,朱红伟,等.三枚与四枚空心螺钉平行固定治疗Pauwels Ⅲ型股骨颈骨折的比较研究[J].中国骨与关节杂志, 2021, 10(6):431-436. DOI:10.3969/j.issn.2095-252X.2021.06.006.Wu GY, Yu QJ, Zhu HW, et al.Three or four cannulated screws in the treatment of Pauwels type Ⅲ femoral neck fracture[J]. Chinese Journal of Bone and Joint, 2021,10(6):431-436. DOI:10.3969/j.issn.2095-252X.2021.06.006.
[17]	金霖. 两种确定肱骨近端锁定钢板螺钉长度的手术方法的疗效分析[D]. 石家庄:河北医科大学, 2014:1-18. DOI:10.7666/d.Y2583108.Jin L.Clinical effects of two surgical methods for determining the screw depth of locking proximal humeral plate[D]. Shijiazhuang: Hebei Medical University, 2014: 1-18. DOI:10.7666/d.Y2583108.