| Objective:The clinical efficacy of conservative treatment and closed reduction and cannulated screw fixation in the treatment of elderly patients with Garden I and type II femoral neck fractures.Method:There are a total of 58 patients aged over 60 years old with femoral neck fracture diagnosed as GardenI and II were enrolled in our department from March 2015 to June 2017.The clinical data were analyzed in 25 cases,including 33 males and 33 females.63-90 years old,38 cases on the left side,20 cases on the right side;according to the different treatment methods,they were divided into the bed traction traction treatment group(group A,23 cases)and the closed reduction cannulated screw internal fixation group(group B,35 example).The gender composition ratio and age of the two groups were compared.The patients were followed up at different times after discharge.The hospitalization time of the two groups,the time of non-weight-bearing exercise,and the time of full weight-bearing were compared and compared.Hip scores of the hips at 1,3,6 and 12 months after surgery,as well as complications such as hemorrhoids,pneumonia,deep vein thrombosis,femoral head necrosis,fracture nonunion,secondary displacement,intractable pain,and death at the last follow-up The t-test or chi-square test was used to compare and analyze the data between the two groups.Result:All patients were followed up for 12 to 24 months.There was no significant difference in the general data of age,gender composition,injury site(L /R)and post-injury time(P>0.05).The average length of hospital stay in the conservative treatment group was 4.22±0.998(d),which was shorter than that of the closed reduction cannulated internal fixation group of 7.77±1.262(d).The difference was statistically significant(P<0.05).Partial weight-bearing time and total weight-bearing time in group A were longer than those in group B,and the differences were statistically significant(P<0.05).The incidence of postoperative complications in group A was 15 cases,the incidence rate was 65.22%,and the value was higher than that in group B(31.43%),and the difference was statistically significant(P<0.05).In the conservative treatment group,there were 2 cases of hemorrhoids,2 cases of nonunion of fracture,1 case of intractable pain,3 cases of femoral head necrosis,4 cases of deep vein thrombosis,1 case of pulmonary infection,2 cases of secondary displacement of fracture;closed reduction hollow In the nail fixation group,1 case of hemorrhoids,2 cases of nonunion of fracture,2 cases of intractable pain,3 cases of femoral head necrosis,1 case of deep vein thrombosis,2 cases of pneumonia,and 2 patients in the two groups at the last follow-up Death,the complications and mortality between the two groups were statistically insignificant(P>0.05),but the proportion of complications such as secondary displacement and deep venous thrombosis in the two groups was quite different.Group A and The comparison of group B was 2(8.70%)/0 and 4(17.39%)/1(2.86%)respectively.Considering of the small sample size,it can be considered as a reference for clinical practice.There was a statistically significant difference in Harris hip function score between the two groups at 1 and 3 months after surgery(P<0.05).There was no significant difference between the Harris scores of the two groups and the excellent Harris scores in December and December(P>0.05).Conclusion:For patients which age over 60 years old with Garden I and type II femoral neck fractures.whether closed reduction cannulated internal fixation or conservative treatment of bed traction can achieve better long-term results.There was a statistically significant difference in the incidence of total complication between the two groups(P<0.05).It can be considered that closed reduction and internal fixation has an advantage in reducing the incidence of complications,but there is no statistical difference in the incidence of various types of complications.May be caused by insufficient sample size.Compared with the conservative treatment group,the cannulated internal fixation group had better recovery of hip function and had better early curative effect,which was beneficial to the early rehabilitation of patients.Therefore,for patients with GardenI and II elderly femoral neck fractures,it is recommended to perform early surgical treatment,which can reduce the occurrence of complications while early lower extremity functional exercise,and the closed reduction and internal fixation is less traumatic and satisfactory.Can be used as one of the clinical preferred procedures. |
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