摘要目的 探讨双针复位架辅助复位技术在GardenⅢ、Ⅳ型股骨颈骨折治疗中的应用效果. 方法 回顾性分析2015年5月至2017年10月期间山西医科大学第二附属医院骨科收治的67例GardenⅢ、Ⅳ型股骨颈骨折患者资料.根据复位方式不同分为两组,双针复位架组37例,男21例,女16例;年龄为(46.2±8.1)岁;骨折Garden分型:Ⅲ型13例,Ⅳ型24例;采用双针复位架辅助复位空心钉固定治疗.手法复位组30例,男18例,女12例;年龄为(48.8±9.1)岁;骨折Garden分型:Ⅲ型13例,Ⅳ型17例;采用手法复位空心钉固定治疗.比较两组患者的复位时间、解剖复位率、手术时间、术中出血量、骨折愈合时间、术后并发症发生率及术后18个月髋关节Harris评分等. 结果 两组患者术前一般资料比较差异均无统计学意义(P＞0.05),具有可比性.67例患者术后获20～30个月(平均24个月)随访.双针复位架组患者的解剖复位率[94.6％ (35/37)]显著高于手法复位组患者[83.3％ (25/30)],复位时间[(33.2±4.6)min]、手术时间[(70.2±5.0)min]和骨折愈合时间[(4.6±0.7)个月]显著短于手法复位组患者[(45.8±8.6) min、(90.6±9.2) min、(5.6±0.6)个月],术后18个月髋关节Harris评分[(84.3±8.6)分]显著高于手法复位组患者[(81.2±7.8)分],差异均有统计学意义(P＜0.05).而两组患者的术中出血量和术后并发症发生率比较差异均无统计学意义(P＞0.05). 结论 双针复位架辅助复位技术具有创伤小、操作简单、解剖复位率高、复位时间短及功能恢复好等优点,是GardenⅢ、Ⅳ型股骨颈骨折较理想的复位方式.

abstractsObjective To compare the efficacy between reduction assisted by a double-needle repositor and manual reduction in the treatment of femoral neck fractures of Garden types Ⅲ-Ⅳ.Methods From May 2015 to October 2017,67 patients with femoral neck fracture of Garden type Ⅲ or Ⅳ were treated by hollow screw fixation at Department of Orthopaedics,The Second Affiliated Hospital to Shanxi Medical University.They were divided into 2 groups according to the different reduction methods.The reduction was assisted by a double-needle repositor in 37 cases (group A);they were 21 males and 16 females with an age of 46.2 ± 8.1 years and there were 13 cases of Garden type Ⅲ and 24 cases of Garden type Ⅳ.The reduction was conducted manually in another 30 cases (group B);they were 18 males and 12 females with an age of 48.8 ± 9.1 years and there were 13 cases of Garden type Ⅲ and 17 cases of Garden type Ⅳ.The 2 groups were compared in terms of reduction time,anatomical reduction rate,operation time,intraoperative bleeding volume,fracture healing time,postoperative complications and Harris hip scores at the last follow-up.Results There were no significant differences between the 2 groups of patients in their preoperative general data,indicating they were compatible(P ＞ 0.05).All the 67 patients were followed up for 20 to 30 months (average,24 months).The anatomic reduction rate in group A [94.6％ (35/37)] was significantly higher than that in group B [83.3％ (25/30)];the reduction time,operation time and fracture healing time in group A (33.2 ±4.6 min,70.2 ±5.0 min and 4.6 ±0.7 months) were significantly shorter than those in group B (45.8 ±8.6 min,90.6 ± 9.2 min and 5.6 ± 0.6 months);the Harris hip scores at the last follow-up in group A (84.3 ± 8.6 points) were significantly higher than in group B (81.2 ±7.8 points) (all P ＜0.05).There was no significant difference in intraoperative bleeding volume or postoperative complications between the 2 groups (P ＞ 0.05).Conclusion Reduction assisted by a double-needle repositor is fine for femoral neck fractures of Garden types of Ⅲ-Ⅳ,because it has advantages of limited invasion,simplicity,a high rate of anatomical reduction,quick reduction and good functional recovery.