刘冠虹 吉万波 刘锦涛

摘要：目的  分析股密葆干預治疗股骨颈骨折的临床疗效。方法  选取2017年1月～2018年3月我科收治住院的接受闭合复位空心钉内固定手术的肾虚血瘀型股骨颈骨折患者48例，采用随机数字表法分为对照组和治疗组，每组24例。对照组行闭合复位空心拉力螺钉内固定术，治疗组在对照组基础上于术后1周口服股密葆方。比较两组骨折愈合时间，术后6个月和12个月Harris评分、PCS和MCS得分，术后12个月股骨颈短缩情况，以及末次随访时步行能力，评价两组治疗方法的优劣。结果  治疗组平均骨折愈合时间为（5.00±2.39）个月，短于对照组的（6.72±3.18）个月，差异具有统计学意义（P<0.05）。两组术后6个月和12个月Harris评分、术后6个月PCS和MCS得分、术后12个月MCS得分比较，差异无统计学意义（P>0.05）;术后12个月，治疗组PCS得分高于对照组（P<0.05）。两组术后12个月时股骨颈短缩情况以及末次随访时步行能力比较，差异无统计学意义（P>0.05）。结论  股密葆方干预治疗股骨颈骨折短期疗效显著，可促进骨折愈合、改善患者术后12个月关节功能及生理功能。

关键词：股骨颈骨折;肾虚血瘀型;闭合复位空心拉力螺钉内固定术;股密葆;Harris评分

中图分类号：R274.12                                文献标识码：A                                DOI：10.3969/j.issn.1006-1959.2019.18.020

文章编号：1006-1959（2019）18-0063-05

Abstract：Objective  To analyze the clinical efficacy of femoral hernia intervention in the treatment of femoral neck fractures. Methods  From January 2017 to March 2018， 48 patients with femoral neck fractures of the kidney and blood stasis type who underwent closed reduction and cannulated internal fixation were enrolled in the hospital. The patients were divided into the control group and the treatment group by random number table.24 cases in each group. The control group underwent closed reduction and lag screw internal fixation. The treatment group received oral administration of sputum at 1 week after operation. The fracture healing time was compared between the two groups. Harris score， PCS and MCS scores at 6 and 12 months postoperatively， femoral neck shortening at 12 months postoperatively， and walking ability at the last follow-up good or bad. Results  The averagefracture healing time of the treatment group was （5.00±2.39） months， which was shorter than that of the control group （6.72±3.18） months，the difference was statistically significant （P<0.05）. There were no significant differences in the Harris scores between the two groups at 6 months and 12 months， the PCS and MCS scores at 6 months after surgery， and the MCS scores at 12 months after surgery （P>0.05）. The PCS score of the treatment group was higher than that of the control group （P<0.05）. There was no significant difference in the femoral neck shortening between the two groups at 12 months postoperatively and at the last follow-up （P>0.05）. Conclusion  The short-term effect of the treatment of femoral neck fracture with femoral hernia is significant， which can promote fracture healing and improve joint function and physiological function in patients 12 months after operation.

Key words：Femoral neck fracture;Kidney deficiency and blood stasis type;Closed reduction and hollow lag screw internal fixation;Femoral hernia;Harris score

股骨颈骨折虽然发生率较低，但可能导致终身残疾，对于65岁以下股骨颈骨折患者，无论移位程度如何，为保留原有关节恢复最大功能，解剖复位内固定是其首选治疗方法。随着患者预期寿命的延长，如果采用髋关节成形术治疗，手术翻修的风险可能会增加。年轻患者股骨颈骨折治疗是一项复杂的挑战，最近的一项荟萃分析提出，其骨折相关后遗症的发生率高达20%～30%，其中最常见的是骨折不愈合、股骨头坏死（osteonecrosis of the femoral head，ONFH）和固定失败[1]。近年来，中医从整体观念、辨证施治的角度干预治疗股骨颈骨折，以减少骨折术后并发症逐渐得到重视，本次研究采用股密葆方治疗股骨颈骨折疗效满意，现报道如下。……