Clinical study for preoperative traction on impact of osteonecrosis of femoral head in patients with femoral neck fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Haibo ¹ , XU Shengxi ¹ , TANG Xuexia ¹ , WANG Na ¹ , XU Lin ¹ , WANG Yue ² , LU Bing ² ,  GOU Yongsheng ¹

1. Department of Orthopaedics, the First People’s Hospital of Shuangliu District, Chengdu Sichuan, 610200, P.R.China;
2. Department of Orthopaedics, Sichuan Academy of Medical Science & Sichuan Provincial People’s Hospital, Chengdu Sichuan, 610072, P.R.China;

Corresponding?author：

GOU Yongsheng, Email: 15002828117@163.com

Keywords：

Femoral neck fracture; osteonecrosis of the femoral head; intracapsular pressure; preoperative traction

DOI：

10.7507/1002-1892.201901019

Video：

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Objective To explore the impact of preoperative traction on the osteonecrosis of the femoral head (ONFH) in patients with femoral neck fractures. Methods Between February 2013 and May 2016, 120 patients with femoral neck fractures, who were treated with screw fixation, were collected. Sixty patients with fractures of Garden type Ⅰ and Ⅱ were non-displaced fracture group; 60 cases with fractures of Garden type Ⅲ and Ⅳ were displaced fracture group. The patients in 2 groups were randomly divided into traction and non-traction subgroups (n=30). There was no significant difference in gender, age, injury mechanism, damage side, the time from injury to operation, and fracture classification between 2 subgroups (P>0.05). Intracapsular pressure was recorded before operation. The quality of fracture reduction and the satisfaction ratio of screw implant were evaluated during operation. Visual analogue scale (VAS), Harris score, joint mobility, and the incidence of ONFH would be evaluated at 6 months, 1 year, and 2 years after operation. Results All incisions of 2 groups healed by first intention after operation. There was no infection or deep vein thrombosis of lower extremity. All patients were followed up 2 years. In displaced and non-displaced fracture groups, the intracapsular pressure of traction subgroups were higher than that of non-traction group (P<0.05); the differences of the quality of fracture reduction and the satisfaction ratio of screw implant were not significant (P>0.05) between 2 subgroups. At 6 months, 1 year, and 2 years after operation, VAS scores were higher in traction subgroup than in non-traction subgroup (P<0.05); and the joint mobility and Harris scores were lower in traction subgroup than in non-traction subgroup (P<0.05). X-ray films showed all fractures healed. Except for the non-displaced group at 6 months, the incidences of ONFH were higher in traction subgroup than in non-traction subgroup at other time points (P< 0.05). Conclusion Preoperative traction may increase the risk of ONFH, which can increase the intracapsular pressure and affect the blood supply of femoral head.

Citation： LI Haibo, XU Shengxi, TANG Xuexia, WANG Na, XU Lin, WANG Yue, LU Bing, GOU Yongsheng. Clinical study for preoperative traction on impact of osteonecrosis of femoral head in patients with femoral neck fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(6): 671-675. doi: 10.7507/1002-1892.201901019 Copy

1.	李智勇, 孫然, 張奇, 等. 2064例股骨頸骨折流行病學調查. 中華創傷雜志, 2009, 25(12): 1064-1067.
2.	張英澤. 股骨頸骨折治療方案選擇策略與進展. 中國骨傷, 2015, 28(9): 781-783.
3.	張弢, 陳偉, 張奇, 等. 早期干預預防股骨頸骨折并發癥的臨床研究. 河北醫藥, 2009, 31(2): 226.
4.	李冀, 李眾利, 蘇祥正, 等. 小直徑多孔道髓芯減壓聯合髖關節鏡清理治療早期股骨頭缺血性壞死的療效觀察. 中國修復重建外科雜志, 2017, 31(9): 1025-1030.
5.	顧小明, 黃立新. 股骨頸骨折空心加壓螺釘內固定后股骨頭壞死分析. 實用骨科雜志, 2014, 20(10): 900-905.
6.	謝康, 高維陸, 常俊, 等. 股骨頸骨折修復后股骨頭壞死7個相關因素: 199例回顧分析. 中國組織工程研究, 2016, 20(24): 3529-3534.
7.	徐劍鋒, 鄒祝藝, 丁東勝, 等. 早期關節內減壓加自體紅骨髓移植聯合治療青壯年股骨頸骨折的臨床應用. 實用骨科雜志, 2016, 22(9): 791-794.
8.	石利濤, 劉彥博, 杜金鵬, 等. 股骨頸骨折術中快速準確置入空心螺釘的手術技巧. 湖南中醫藥大學學報, 2016, (a2): 1231-1232.
9.	曹延祥, 趙燕鵬, 胡磊, 等. 基于誤差糾正算法的計算機輔助股骨頸骨折空心螺釘內固定系統的臨床應用研究. 中國修復重建外科雜志, 2017, 31(3): 257-261.
10.	朱乃彬, 魏良熙. 空心加壓螺紋釘內固定及術后康復訓練對股骨頸骨折患者髖膝關節功能的影響. 中國臨床康復, 2005, 9(6): 23-24.
11.	梁凡, 彭昊, 胡巍, 等. 股骨頸骨折術后繼發股骨頭壞死的危險因素分析. 中華創傷雜志, 2016, 32(9): 813-817.
12.	曹發奇, 周武, 劉國輝, 等. 股骨頸骨折復位內固定術后股骨頭壞死的相關因素分析. 中華骨科雜志, 2017, 37(17): 1088-1092.
13.	Hammer A. The structure of the femoral neck: A physical dissection with emphasis on the internal trabecular system. Ann Anat, 2010, 192(3): 168-177.
14.	王子華, 趙德偉. 基于顯微灌注和三維數字成像的股骨頭血供解剖學研究為青壯年股骨頸骨折治療策略帶來的新啟示. 中華顯微外科雜志, 2017, 40(5): 417-418.
15.	趙德偉, 邱興. 股骨頭血液供應及其臨床意義. 臨床外科雜志, 2017, 25(8): 568-570.
16.	Drake JK, Meyers MH. Intracapsular pressure and hemarthrosis following femoral neck fracture. Clin Orthop Relat Res, 1984, (182): 172-176.
17.	華祖廣, 龐清江, 鄭興國. 股骨頸骨折后髖關節囊壓力改變的臨床研究. 現代實用醫學, 2008, 20(1): 11-12.
18.	伍凱, 張明貴, 曹云, 等. 股骨頸骨折后關節囊壓力對股骨頭血供的影響. 中國矯形外科雜志, 2002, 10(10): 984-986.
19.	王峰, 方靜, 徐義, 等. 綜合評價骨牽引、內固定與人工關節置換術治療老年股骨頸骨折的療效. 中國廠礦醫學, 2007, 20(2): 113-115.
20.	楊秀軍, 肖湘生. 牽引、內旋位對股骨頸骨折早期股骨頭血運影響的超選擇DSA研究. 中華放射學雜志, 2005, 39(8): 812-816.
21.	R?dén M, Sch?n M, Fredin H. Treatment of displaced femoral neck fractures: a randomized minimum 5-year follow-up study of screws and bipolar hemiprostheses in 100 patients. Acta Orthop Scand, 2003, 74(1): 42-44.

1. 李智勇, 孫然, 張奇, 等. 2064例股骨頸骨折流行病學調查. 中華創傷雜志, 2009, 25(12): 1064-1067.
2. 張英澤. 股骨頸骨折治療方案選擇策略與進展. 中國骨傷, 2015, 28(9): 781-783.
3. 張弢, 陳偉, 張奇, 等. 早期干預預防股骨頸骨折并發癥的臨床研究. 河北醫藥, 2009, 31(2): 226.
4. 李冀, 李眾利, 蘇祥正, 等. 小直徑多孔道髓芯減壓聯合髖關節鏡清理治療早期股骨頭缺血性壞死的療效觀察. 中國修復重建外科雜志, 2017, 31(9): 1025-1030.
5. 顧小明, 黃立新. 股骨頸骨折空心加壓螺釘內固定后股骨頭壞死分析. 實用骨科雜志, 2014, 20(10): 900-905.
6. 謝康, 高維陸, 常俊, 等. 股骨頸骨折修復后股骨頭壞死7個相關因素: 199例回顧分析. 中國組織工程研究, 2016, 20(24): 3529-3534.
7. 徐劍鋒, 鄒祝藝, 丁東勝, 等. 早期關節內減壓加自體紅骨髓移植聯合治療青壯年股骨頸骨折的臨床應用. 實用骨科雜志, 2016, 22(9): 791-794.
8. 石利濤, 劉彥博, 杜金鵬, 等. 股骨頸骨折術中快速準確置入空心螺釘的手術技巧. 湖南中醫藥大學學報, 2016, (a2): 1231-1232.
9. 曹延祥, 趙燕鵬, 胡磊, 等. 基于誤差糾正算法的計算機輔助股骨頸骨折空心螺釘內固定系統的臨床應用研究. 中國修復重建外科雜志, 2017, 31(3): 257-261.
10. 朱乃彬, 魏良熙. 空心加壓螺紋釘內固定及術后康復訓練對股骨頸骨折患者髖膝關節功能的影響. 中國臨床康復, 2005, 9(6): 23-24.
11. 梁凡, 彭昊, 胡巍, 等. 股骨頸骨折術后繼發股骨頭壞死的危險因素分析. 中華創傷雜志, 2016, 32(9): 813-817.
12. 曹發奇, 周武, 劉國輝, 等. 股骨頸骨折復位內固定術后股骨頭壞死的相關因素分析. 中華骨科雜志, 2017, 37(17): 1088-1092.
13. Hammer A. The structure of the femoral neck: A physical dissection with emphasis on the internal trabecular system. Ann Anat, 2010, 192(3): 168-177.
14. 王子華, 趙德偉. 基于顯微灌注和三維數字成像的股骨頭血供解剖學研究為青壯年股骨頸骨折治療策略帶來的新啟示. 中華顯微外科雜志, 2017, 40(5): 417-418.
15. 趙德偉, 邱興. 股骨頭血液供應及其臨床意義. 臨床外科雜志, 2017, 25(8): 568-570.
16. Drake JK, Meyers MH. Intracapsular pressure and hemarthrosis following femoral neck fracture. Clin Orthop Relat Res, 1984, (182): 172-176.
17. 華祖廣, 龐清江, 鄭興國. 股骨頸骨折后髖關節囊壓力改變的臨床研究. 現代實用醫學, 2008, 20(1): 11-12.
18. 伍凱, 張明貴, 曹云, 等. 股骨頸骨折后關節囊壓力對股骨頭血供的影響. 中國矯形外科雜志, 2002, 10(10): 984-986.
19. 王峰, 方靜, 徐義, 等. 綜合評價骨牽引、內固定與人工關節置換術治療老年股骨頸骨折的療效. 中國廠礦醫學, 2007, 20(2): 113-115.
20. 楊秀軍, 肖湘生. 牽引、內旋位對股骨頸骨折早期股骨頭血運影響的超選擇DSA研究. 中華放射學雜志, 2005, 39(8): 812-816.
21. R?dén M, Sch?n M, Fredin H. Treatment of displaced femoral neck fractures: a randomized minimum 5-year follow-up study of screws and bipolar hemiprostheses in 100 patients. Acta Orthop Scand, 2003, 74(1): 42-44.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical study for preoperative traction on impact of osteonecrosis of femoral head in patients with femoral neck fractures

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