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

目的: 探讨术前牵引对股骨颈骨折术后发生股骨头缺血性坏死（osteonecrosis of the femoral head，ONFH）的影响。. 方法: 以 2013 年 2 月—2016 年 5 月行空心螺钉固定的股骨颈骨折患者作为研究对象，其中 120 例符合选择标准纳入研究。60 例 Garden Ⅰ、Ⅱ型患者为骨折无移位组，60 例 Garden Ⅲ、Ⅳ型为骨折移位组；两组患者均随机分为牵引、非牵引亚组，各亚组 30 例。骨折移位及无移位组中，两亚组患者性别、年龄、致伤原因、损伤侧别、受伤至手术时间以及骨折分型比较，差异均无统计学意义（ P>0.05），具有可比性。术前记录患髋关节囊内压；术中复位固定后，评价骨折复位质量及螺钉植入满意率；术后 6 个月、1 年、2 年记录疼痛视觉模拟评分（VAS）、关节功能 Harris 评分、关节活动度，以及 ONFH 发生情况。. 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) 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.