利用正前開和內側支撐鋼板治療年輕人股骨頸骨折之研究

Using a Direct Anterior Approach and Medial Buttress Plate Sin the Treatment of Pauwels Type III Femoral Neck Fractures in Young Patients

年輕患者的股骨頸骨折，特別是Pauwels III型骨折，由於骨折區具有很高的剪力和不易解剖復位，用傳統手術方法具有很高的失敗率和併發症。本研究旨在評估在常規固定方法之外使用正前開和內側支撐鋼板治療年輕患者Pauwels III型股骨頸骨折的安全性和有效性。回顧性病例系列研究納入15例接受內側支撐鋼板和常規固定（空心螺釘或動力髖螺釘）治療的Pauwels III型股骨頸骨折患者（12例男性，3例女性；平均年齡38.6歲）。主要結果指標為骨折癒合、缺血性壞死和植入物鬆脫，次要結果指標包括Harris髖關節評分（HHS）和疼痛視覺模擬量表（VAS）。在平均18個月的追蹤裡，所有骨折均已癒合，無缺血性壞死或植入物失效病例。HHS平均值從術後3個月的58.3分提高到12個月的86.5分，VAS平均值從術後3個月的6.2分降低到12個月的1.8分。1例患者出現表淺傷口感染，另1例患者出現持續髖關節疼痛和活動受限。根據研究結果，使用正前開和內側支撐鋼板搭配傳統內植物是治療年輕患者Pauwels III型股骨頸骨折的一種安全有效的技術，可提供更好的骨折穩定性並降低併發症風險。

Fractures of the femoral neck in young patients, particularly Pauwels type III fractures, are challenging to treat due to high shear forces and a high risk of complications. The objective of this case series study is to evaluate the safety and efficacy of using a medial buttress plate with the direct anterior approach in addition to standard fixation methods for the treatment of Pauwels type III femoral neck fractures in young patients. We conducted a retrospective case series of 10 patients (8 males, 2 females; mean age 35.2 years) with Pauwels type III femoral neck fractures treated with a medial buttress plate and standard fixation (dynamic hip screw or cannulated screws). The primary outcome measures were fracture union, avascular necrosis, and implant failure, while secondary outcome measures included a visual analog scale (VAS) for pain and Harris Hip Score (HHS). At a mean follow-up of 18 months, all fractures had achieved union without cases of avascular necrosis or implant failure. The mean HHS improved from 58.3 at 3 months to 86.5 at 12 months, and the mean VAS score decreased from 6.2 at 3 months to 1.8 at 12 months postoperatively. One patient had a subcutaneous wound infection, and another had mild limited deep flexion and hip pain. The use of the direct anterior approach and a medial buttress plate in addition to standard fixation methods appears to be a safe and effective technique for treating Pauwels type III femoral neck fractures in relatively young patients, providing better fracture stability and reduced risk of complications. However, longer follow-up and studies with larger samples are needed in future investigations to address these challenging fractures.