| 正位Garden指数对老年股骨颈GardenⅢ型骨折亚分型的评估及其临床意义 |
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Received:March 20, 2016
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| 作者 | Author | 单位 | Unit | E-Mail |
| 侯洪涛 |
HOU Hong-tao |
洛阳正骨医院 河南省骨科医院髋部疾病研究治疗中心, 河南 洛阳 471002 |
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| 李无阴 |
LI Wu-yin |
洛阳正骨医院 河南省骨科医院髋部疾病研究治疗中心, 河南 洛阳 471002 |
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| 刘又文 |
LIU You-wen |
洛阳正骨医院 河南省骨科医院髋部疾病研究治疗中心, 河南 洛阳 471002 |
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| 陈柯 |
CHEN Ke |
洛阳正骨医院 河南省骨科医院髋部疾病研究治疗中心, 河南 洛阳 471002 |
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| 仝昭方 |
TONG Zhao-fang |
洛阳正骨医院 河南省骨科医院髋部疾病研究治疗中心, 河南 洛阳 471002 |
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| 海洋 |
HAI Yang |
洛阳正骨医院 河南省骨科医院髋部疾病研究治疗中心, 河南 洛阳 471002 |
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| 吴亦新 |
WU Yi-xin |
洛阳正骨医院 河南省骨科医院髋部疾病研究治疗中心, 河南 洛阳 471002 |
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| 马文龙 |
MA Wen-long |
洛阳正骨医院 河南省骨科医院髋部疾病研究治疗中心, 河南 洛阳 471002 |
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| 叶晔 |
YE ye |
洛阳正骨医院 河南省骨科医院髋部疾病研究治疗中心, 河南 洛阳 471002 |
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| 田可为 |
TIAN Ke-wei |
洛阳正骨医院 河南省骨科医院髋部疾病研究治疗中心, 河南 洛阳 471002 |
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| 陈武林 |
CHEN Wu-lin |
洛阳正骨医院 河南省骨科医院髋部疾病研究治疗中心, 河南 洛阳 471002 |
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| 王坤正 |
WANG Kun-zheng |
西安交通大学第二附属医院, 陕西 西安 710004 |
The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shanxi, China |
wkzh1955@163.com |
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| 期刊信息：《中国骨伤》2016年29卷，第11期，第982-988页 |
| DOI：10.3969/j.issn.1003-0034.2016.11.003 |
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目的：探讨老年GardenⅢ型股骨颈骨折移位程度的差异，分析其亚分型依据及分型的临床意义。
方法：对2005年9月至2010年9月采用闭合复位空心钉内固定术治疗的492例老年股骨颈Garden Ⅲ型骨折患者的临床资料进行回顾性分析，以正位Garden指数判别骨折移位程度，分为：A型，Garden指数≥140°，137例，男53例，女84例，平均（65.3±7.2）岁；B型，120°< Garden指数< 140°，251例，男79例，女172例，平均（67.5±3.6）岁；C型，Garden指数≤120°，104例，男38例，女66例，平均（68.6±5.7）岁。对患者并发症、骨折愈合、转归、髋关节功能等情况随访，比较3个亚型患者骨折愈合及股骨头坏死情况。
结果：术后刀口均Ⅰ期愈合，无感染等并发症发生。患者均获随访，时间2~10年，平均6.3年。432例骨折愈合，愈合率87.8%，83例股骨头坏死，坏死率16.9%.A型不愈合率6.6%，与B型13.5%，C型16.3%，3型间比较差异有统计学意义（χAB2=4.377，P=0.036；χAC2=5.872，P=0.015；χBC2=0.469，PBC=0.494）；A型股骨头坏死率8.8%，B型16.7%，C型27.9%，3型间比较差异均有统计学意义（χAB2=4.704 P=0.03；χAC2=15.317，P=0.00；χBC2=5.715，P=0.17）.
结论：老年GardenⅢ型股骨颈骨折移位程度不同，可以按股骨颈正位Garden指数评价移位程度，根据移位程度将其分为3个亚型；老年GardenⅢ型股骨颈骨折可采用内固定术治疗，其预后与移位程度相关，在制定治疗方案时应区别对待。 |
| [关键词]:股骨颈骨折 骨折,不愈合 股骨头坏死 老年人 骨折固定术,内 |
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| Subtype classification of Garden Ⅲ femoral neck fractures in the elderly based on frontal Garden index and its clinical significance |
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Abstract:
Objective: To retrospectively study postoperative Garden Ⅲ femoral neck fractures in the elderly so as to explore the different degree of displacement of Garden Ⅲ femoral neck fracture,and discuss the basis and clinical significance of the subtype classification.
Methods: A total of 492 patients with complete clinical data out of the 1397 patients with femoral neck fractures treated by closed reduction and internal fixation with cannulated compression screws from September 2005 to September 2010 were included in the study. Each patient's frontal Garden Index was measured. On the basis of the frontal Garden Index,these cases were divided into three types:type A,which frontal Garden Index was more than or equal to 140°,included 53 males and 84 females with an average age of(65.3±7.2) years old ranging from 60 to 75 years old;type B,more than 120°and less than 140°,included 79 males and 172 females with an average age of (67.5±3.6) years old;and type C,less than or equal to 120°,included 38 males and 66 with an average age of(68.6±5.7) years old. Aspects were followed up including complications,consequences and hip joint function. The fracture healing and femoral head necrosis were compared among three types.
Results: Operative incision of 492 cases was primary healing,and no infection and other complications occurred. All patients were followed up from 2 to 10 years with an average of 6.3 years,the healing of femoral neck fracture occurred in 432 cases,and the total union rate was 87.8%. Femoral head necrosis occurred in 83 cases,and the total necrosis rate of femoral head was 16.9%. The nonunion rate of type A was 6.6%,type B was 13.5%,and type C was 16.3%,there were significant differences among three types(χAB2=4.377,P=0.036；χAC2=5.872,P=0.015；χBC2=0.469,PBC=0.494). The necrosis rate of femoral head of group A was 8.8%,group B was 16.7%,and group C was 27.9%,there were significant differences among three groups(χAB2=4.704 P=0.03；χAC2=15.317,P=0.00；χBC2=5.715,P=0.17).
Conclusion: It is different for the degree of displacement of Garden Ⅲ femoral neck fracture in the elderly. Based on frontal Garden Index to differentiate degree of fracture displacement,Garden Ⅲ femoral neck fracture would be divided into A,B and C subtypes. The prognosis of Garden Ⅲ femoral neck fracture in the elderly is negatively related to its degree of displacement,which has clinical significance to make treatment plan for Garden Ⅲ femoral neck fracture in the elderly. |
| KEYWORDS:Femoral neck fractures Fractures,ununited Femur head necrosis Aged Fracture fixation,internal |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 侯洪涛,李无阴,刘又文,陈柯,仝昭方,海洋,吴亦新,马文龙,叶晔,田可为,陈武林,王坤正.正位Garden指数对老年股骨颈GardenⅢ型骨折亚分型的评估及其临床意义[J].中国骨伤,2016,29(11):982~988 |
| 英文格式: | HOU Hong-tao,LI Wu-yin,LIU You-wen,CHEN Ke,TONG Zhao-fang,HAI Yang,WU Yi-xin,MA Wen-long,YE ye,TIAN Ke-wei,CHEN Wu-lin,WANG Kun-zheng.Subtype classification of Garden Ⅲ femoral neck fractures in the elderly based on frontal Garden index and its clinical significance[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(11):982~988 |
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