交叉与平行空心螺钉固定GardenⅠ和Ⅱ型股骨颈骨折比较△

Comparison of interlocking versus parallel cannulated screws for internal fixation of Garden type I and II femoral neck fractures

摘要:

[目的]比较交叉与平行空心螺钉固定 Garden Ⅰ和Ⅱ型股骨颈骨折的效果。[方法]回顾性分析 2015 年 1 月—2016 年 12 月手术治疗的 Garden Ⅰ和Ⅱ型股骨颈骨折 26 例患者的临床资料，其中 12 例采用交叉空心螺钉治疗(交叉组)，14 例采用平行空心螺钉治疗(平行组)，比较两组临床与影像学资料。[结果]两组患者均顺利完成手术，无严重并发症。两组手术时间、术中透视次数差异均无统计学意义 (P＞0.05)。所有患者均获随访 12 个月以上。交叉组恢复完全负重时间和末次随访时 Harris 评分均显著优于平行组(P＜0.05)。影像方面，术后 12 个月交叉组股骨高度丢失、股骨距丢失、股骨颈轴向长度短缩和螺钉退出程度均显著小于平行组 P＜0.05)。[结论]交叉空心螺钉固定 Garden Ⅰ和Ⅱ型股骨颈骨折，可有效控制股骨颈骨折短缩及减少螺钉尾部退出，提高髋关节功能。

Abstract:

[Objective] To compare the clinical outcomes of interlocking versus parallel cannulated screws for internal fixation of Gar- den type I and II femoral neck fractures. [Methods] A retrospective study was done on 26 patients who received closed reduction and inter- nal fixation for Garden type I and II femoral neck fractures from January 2015 to December 2016 in our department. Of them, 12 patients had 3 cannulated screws placed interlocking each other (the interlocking group), while the remaining 14 patients had 3 cannulated screws inserted parallelly (the parallel group) . The clinical and imaging data were compared between the two groups. [Results] All patients in both groups had operation completed successfully without serious complications. There were no significant differences in operative time and in- traoperative fluoroscopy times between the two groups (P＞0.05) . All patients were followed up for more than 12 months. The interlocking group proved significantly superior to the parallel group in terms of time to resume full weight-bearing activity and Harris score at the last follow-up (P＜0.05) . Radiographically, the interlocking group had significantly less femoral length loss, femoral head offset loss, femoral neck shortening and screw withdrawal than the parallel group at 12 months postoperatively (P＜0.05) . [Conclusion] The cannulated screws placed in interlocking manner for internal fixation of Garden type I and II femoral neck fractures do effectively control femoral neck shorten- ing, reduce screw withdrawal, and improve hip function recovery.