| Objective: To evaluate the clinical efficacy of DAA approach in treatment of the Garden difficult reduction of femoral neck fracture.Ⅲ ⅢMethods: A comprehensive assessment of femoral neck fractures was performed by age,type of fracture,comprehensive living ability,bone mineral density(Singh index),medical comorbidities,and follow-up time after operation.Screen and collect 44 cases of Garden type 3 impacted type,Garden type 4 head rotation type and femoral neck crushing type from the department of trauma orthopedic in the second affiliated hospital of Dalian Medical University from 2012 to 2016,and the 44 femoral neck fracture patients were eligible for internal fixation treatment by three full threaded cannulated compression screws.To retrospectively case-control study of the 21 patients who were treated by open reduction and internal fixation with 3 full threaded cannulated compression screws in DAA approach(Group A,experiment group)and 21 cases in the treatment of closed reduction with 3 full threaded cannulated compression screws fixation(group B,control group).The postoperative hip function recovery evaluation was made according to Harris hip score,The quality of fracture reduction was evaluated by Garden index method,and MS Excel 365 software was used for data collation,the data ofintraoperative and postoperative follow-up data were analyzed by IBM SPSS 22.0 software,further comparison between group A and B in age,sex,fracture type,time from injury to surgery,eduction index,incision length,fracture healing time,Harris hip score and other aspects of difference.Results: In the experimental group A,one patients were diagnosed as femoral head bnecrosis in the second year after operation,which was ARCO phase 2.One patient of group A after 1 year of fracture healing occurred after full thread hollow screw on the articular surface of the femoral piercing.In the control group B,23 patients were followe-d up for 6 months to 4 years.There were 2 cases of femoral head necrosis,1 cases of ARCO 2 and 1 cases of ARCO 3.One of the patients in group B occurred below the full thread hollow screw on the articular surface of the femoral head out,and one patient had a phonomenon of screw withdrawal.because P> 0.05,the A,B groups were not statistically different in age(P = 0.597),gender(P = 0.909),cause of injury(P = 0.947),average length of stay(P = 0.412),time from injury to surgery(P = 0.609),fracture type(P= 0.944),reset index(P= 0.235),number of fracture healing(P =0.427),femoral head necrosis(P =0.261),fracture healing time(P = 0.146),hip Harris score(P = 0.073).two groups have statistical sense in operative time(P = 0.034 <0.05),cut length(P= 0.000 <0.001),intraoperative blood loss(P=0.017<0.05).The mean operative time,mean incision length and intraoperative blood lossin group A were higher than those in group B,The curative effect of fracture healing time,femoral head necrosis and hip Harris score have no statistical differences between group A and group B.Conclusion: 1.Young and middle-aged patients of femoral neck fracture adopt closed reduction internal fixation mainly,in the Garden Ⅲ Ⅳ difficult reduction of femoral neck fracture patients,when closed reduction cant not achieve satisfied effect,DAA approach and open reduction internal fixation is an effective treatment of femoral neck fracture.2.Although the DAA approach and open reduction internal fixation destroy the blood supply of the joint capsule,but it doesn’t increase the femoral neck fracture unable healing rate and rate of femoral head necrosis. |
