4枚与3枚空心钉固定PauwelsⅢ型股骨颈骨折比较

Comparison of four versus three cannulated screws for internal fixation of Pauwels type III femoral neck fractures

摘要:

［目的］ 比较 4 枚与 3 枚空心钉内固定 Pauwels Ⅲ型股骨颈骨折的临床效果。［方法］ 2014 年 1 月—2018 年 11 月， 70 例 Pauwels III 型股骨颈骨折患者纳入本研究，采用抽签法将患者随机分为两组。其中，35 例采用 4 枚空心钉内固定 （四钉组），35 例采用 3 枚空心钉内固定（三钉组），比较两组患者围手术期情况、随访结果和影像资料。［结果］两组患者均顺利完成手术，术中未见血管及神经损伤。四钉组手术时间、术中出血量、切口总长度和术中透视时间均显著大于三钉组 （P< 0.05）。但是，两组住院天数和恢复下地行走时间的差异均无统计学意义（P>0.05）。随访 18～48 个月，平均（26.41±5.02）个月。至末次随访时，因股骨头坏死或骨不连行全髋置换，四钉组为 5/35 （14.26%），三钉组为 7/35 （20.00%）。随术后时间推移，两组患者髋关节各向 ROM 均显著增加 （P<0.05），Harris 评分显著增加 （P<0.05）。相应时间点，四钉组各向髋 ROM 和 Harris 评分均显著优于三钉组 （P<0.05）。影像方面，两组患者骨折复位质量的差异无统计学意义 （P>0.05）。但是，四钉组股骨头颈短缩和颈干角均显著优于三钉组 （P<0.05）。［结论］ 4 枚空心钉固定 Pauwels Ⅲ型股骨颈骨折临床效果优于 3 枚空心钉固定。

Abstract:

[Objective] To compare the clinical outcomes of four versus three cannulated screws for internal fixation of Pauwels type III femoral neck fractures. [Methods] From January 2014 to November 2018, 70 patients with Pauwels type III femoral neck fracture were en- rolled in this study and randomly divided into two groups by lottery. Among them, 35 patients had fractures fixed with 4 cannulated screws (the four-screw group) , while the remaining 35 patients were treated with 3 cannulated screws (the three-screw group). Perioperative condi- tions, follow-up consequences and imaging data were compared between the two groups. [Results] All the patients in both groups had inter- nal fixations performed successfully with no vascular and nerve injury. The four-screw group consumed significantly longer operative time, associated with significantly more intraoperative bleeding, total incision length and intraoperative fluoroscopy frequency than the threescrew group (P＜0.05) . However, there were no significant differences in hospital stay and the time to resume walking between the two groups (P＞0.05) . The follow-up period lasted for 18 to 48 months with a mean of (26.41±5.02) months. To the latest follow-up, total hip ar- throplasty due to femoral head necrosis or nonunion was performed 5/35 (14.26%) in the four-screw group, whereas 7/35 (20.00%) in the three- screw group. The hip range of motion (ROM) in all directions and the Harris score was significantly increased over time in both groups (P＜0.05) . At all the corresponding time points, the four-screw group proved significantly superior to the three-screw group in terms of ROMs and Harris scores (P＜0.05) . With respect to radiographic evaluation, there was no significant difference in fracture reduction qual- ity in term of Garden's alignment index between the two groups (P＞0.05) . However, the four-screw group was significantly superior to the three- screw group in terms of femoral head and neck shortening and neck- shaft angle (P＜0.05) . [Conclusion] The four cannulated screws used in internal fixation of Pauwels type III femoral neck fracture does achieve better clinical outcomes than the three canulated screws.