两种股骨颈骨折内固定方式的近期疗效比较△

Comparison of short-term clinical outcomes of two internal fixation methods for femoral neck fractures

摘要:

［目的］ 比较股骨颈系统 （femoral neck system, FNS） 与倒三角空心螺钉 （inverted cannulated cancellous screws, ICCS）治疗股骨颈骨折的近期临床疗效。［方法］回顾性分析 2018 年 1 月—2021 年 3 月应用内固定术治疗的股骨颈骨折 73 例患者的临床资料。依据术前医患沟通结果，33 例采用 FNS 内固定，40 例采用 ICCS 内固定。比较两组围手术期、随访与影像结果。［结果］ 两组患者均顺利完成手术，术中无神经、血管损伤等严重并发症。两组手术时间、切口总长度、术中失血量、 住院时间差异均无统计学意义 （P>0.05）。FNS 组透视次数及下地活动时间显著优于 ICCS 组 （P<0.05）。患者随访时间平均 （17.91±3.63） 个月，FNS 组完全负重活动时间显著早于 ICCS 组 （P<0.05）。术后随时间推移，两组患者 VAS 评分均显著降低 （P<0.05）；而髋伸屈 ROM、髋内外旋 ROM、Harris 评分显著增加（P<0.05）；末次随访时 FNS 组的 VAS 评分显著优于 ICCS 组 （P<0.05）；相应时间点 FNS 组的 Harris 评分均显著优于 ICCS 组 （P<0.05）。影像方面，两组间复位 Garden 指数差异无统计学意义（P>0.05），但是，FNS 骨折愈合时间、股骨颈短缩方面显著优于 ICCS 组；两组颈干角、T?nnis 髋 OA 分级、骨不连、内固定失败和股骨头坏死发生率差异均无统计学意义（P>0.05）。［结论］FNS 治疗股骨颈骨折具有固定稳定性强、髋关节功能恢复好、骨折愈合快的优点。

Abstract:

[Objective] To compare the short-term clinical outcomes of femoral neck system (FNS) versus inverted cannulated cancel- lous screw (ICCS) for femoral neck fractures. [Methods] A retrospective study was done on 73 patients who received internal fixation for femoral neck fracture from January 2018 to March 2021. According to preoperative doctor-patient communication, 33 patients were treated with FNS, while the remaining 40 patients were with ICCS. The perioperative, follow-up and imaging results were compared between the two groups. [Results] All the patients in both groups were operated on successfully without neurovascular injury and other serious complica- tions. Although there were no significant differences in operative time, total incision length, intraoperative blood loss and hospital stay be- tween the two groups (P＞0.05) , the FNS group proved significantly superior to the ICCS group in terms of intraoperative times of fluorosco- py and postoperative ambulation time (P＜0.05) . The follow-up period lasted for (17.91±3.63) months on an average, and the FNS group re- sumed full- weight-bearing activity significantly earlier than the ICCS group (P＜0.05) . The VAS scores decreased significantly (P＜0.05) , while the hip extension and flexion range of motion (ROM) , hip internal and external rotation ROM, and Harris score significantly in- creased in both groups over time after surgery (P＜0.05) . The FNS group was significantly superior to the ICCC group in terms of VAS score at the latest follow up (P＜0.05) , and Harris score at all corresponding time points postoperatively (P＜0.05) . Radiographically, there was no a statistically significant difference in Garden alignment index between the two groups postoperatively (P＞0.05) , but FNS proved signifi- cantly superior to ICCS group in terms of fracture healing time and femoral neck shortening (P＜0.05) . In addition, there were no significant differences between the two groups in terms of neck-shaft angle, T?nnis hip osteoarthritis grade, as well as incidences of bone nonunion, in- ternal fixation failure and femoral head necrosis (P＞0.05) . [Conclusion] The FNS for internal fixation of femoral neck fracture takes the ad- vantages of strong fixation stability, good recovery of hip function and fast fracture healing.