The Clinical Curative Effect Analysis Of Closed Reduction Compression Cannulated Screw Internal Fixation And Total Hip Arthroplasty In The Treatment Of Femoral Neck Fractures

Objective: This paper selecting patients60to65years of age, wasdesigned to investigate and discuss clinical curative effect of the closedreduction cannulated screw fixation and total hip arthroplasty in thetreatment of femoral neck fractures, with a view to provide some referencefor the treatment in the future clinical work.Methods: Collected femoral neck fracture patients who had been inhospital and undergone the surgical treatments in the second affiliatedhospital of dalian medical university from the year2010to2012. Amongthose, a total of69cases of closed reduction cannulated screw internalfixation and total hip arthroplasty were selected and enrolled. There were27male cases and42female. They were aged from60to65years old, with61.7on average. The33cases were on the left side, while36on the rightside. It took patients2hours to3days from injury to admission. There are37patients in the group of closed reduction cannulated screwfixation.According to Garden Type: Type Ⅰ9cases, Type Ⅱ12cases, TypeⅢ10cases, Type Ⅳ6cases.There are32patients in the group of total hiparthroplasty.According to Garden Type: Type Ⅱ5cases, Type Ⅲ12cases,Type Ⅳ15cases.The follow-up of10to18months postoperatively had beendone, and an average follow-up time was12.7months. Now two kinds ofclosed reduction method are commonly used in clinical. They areMcElvenny method and Leadbetter method. The fracture reduction criteriaadopted the Garden Index to evaluate the level of femoral neck fracture reduction. All the operations were closed reduction three cannulated screwsinternal fixation and total hip arthroplasty. Scoring criteria for medullaryjoint function postoperatively adopted Harris scoring criteria. Collectedrelative data, such as the patients’ age, sex, fracture type, quality ofreduction, complications and postoperative limb functional recovery and soon. And collation, analysis and summary these data.Results: Comparing the group of closed reduction cannulated screwfixation with the group of total hip arthroplasty, the operating timewas statistically significant difference（P<0.05）.The IF group was shorter.Comparing the length of stay,the two groups had nonstatistically significant difference（P>0.05）. Comparing the two groups, theactivity time had statistically significant difference（P<0.05）.After theoperation comparing between the two groups,the difference of excellent andgood rate was not statistically significant（P>0.05）. Comparing the Harrisscore of the excellent and good cases between the two groups, differencewas statistically significant （P<0.05）. The reduction quality is animportant factor to ensure the effect of internal fixation.Conclusion:1.For the60to65age of the femoral neck fracture,with good physicalcondition before injury,non Garden type IV patients expecting higher jointfunction and activity content, can be treated by hollow screw internalfixation for the first time.The reason is that as long as fracture can healwithout serious complication, the hip function would be better than theartificial joint.The Garden type IV patients should be treated by the totalhip replacement, thereby avoiding the poor efficacy and the risk of secondtime operation..2.Closed reduction and cannulated screw fixation has the advantagesof shorter operation time, less operation trauma, less bleeding. This methodis easy to operate with high healing rate,and hip joint function is better afterhealing. And as no serious complication of fracture, the hip function wouldbe better than the artificial joint.But at the same time, the attentions shouldbe paid for high reduction quality. This operation can retain the femoralhead and the cost is relatively low, so it is easy for patients and their families to accept it.3.Total hip arthroplasty has short activity time, so patients can carryout physical and partial weight-bearing as soon as possible, in order torapidly recovery hip function.And hip joint function would be satisfied. Atthe same time, the total hip arthroplasty can prevent the occurrence ofcomplications of the fracture and avoid the fracture nonunion of internalfixation. But the total hip replacement is a one-time treatment, and has itsunavoidable own defect. Therefore, for the treatment of fresh femoral neckfracture, arthroplasty option must be strictly grasp the indications ofoperation and very carefully.