股骨颈系统与空心钉固定青壮年股骨颈骨折△

Femoral neck system versus cannulated screws for femoral neck fractures in young and middle-aged

摘要:

［目的］ 比较股骨颈系统 （femoral neck system, FNS） 与空心钉 （cannulated screws, CS） 治疗青壮年股骨颈骨折的临床疗效。［方法］ 回顾性分析 2019 年 6 月—2021 年 1 月本院诊治的 137 例青壮年股骨颈骨折患者的临床资料，依据医患沟通结果，64 例采用 FNS 固定 （FNS 组）， 73 例采用 CS 固定 （CS 组）。比较两组围手术期、随访和影像资料。［结果］ FNS 组手术时间、透视次数、部分负重时间均优于 CS 组 （P<0.05）。FNS 组在术后 3、7、30 d 的 VAS 评分显著优于 CS 组 （P<0.05）。 两组患者术后均获 12 个月以上随访，FNS 组 1 例 （1.56％），CS 组 2 例 （2.7％） 改行 THA。随术后时间推移，两组 Harris 评分、髋屈-伸及内-外旋 ROM 均显著增加（P<0.05）。术后相应时间点，FNS 组的 Harris 评分、髋屈-伸及内-外旋 ROM 均显著优于 CS 组 （P<0.05）。影像方面，FNS 组影像骨折愈合时间显著早于 CS 组 （P<0.05），术后即刻两组间 Garden 对线指数、股骨颈短缩、颈干角的差异无统计学意义 （P>0.05），末次随访时，FNS 组股骨颈短缩发生率、颈干角及内固定切出率均显著优于 CS 组（P<0.05）。［结论］与 CS 相比，FNS 固定牢靠，利于术后髋关节功能的恢复和骨折愈合，临床疗效更优。

关键词:股骨颈骨折;内固定;股骨颈系统;空心螺钉

Abstract:

[Objective] To compare the clinical outcomes of femoral neck system (FNS) versus cannulated screw (CS) for femoral neck fractures in young and middle- aged. [Methods] A retrospective study was conducted on 137 young and middle- aged patients who had been surgically treated for femoral neck fracture at our hospital from June 2019 to January 2021. Based on preoperative doctor-patient com- munication, 64 patients had the fractures fixed with FNS, while the remaining 73 patients were with CS. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had operation performed smoothly without seri- ous complication. The FNS group proved significantly superior to the CS group in terms of operation time, fluoroscopy frequency, postopera- tive partial weight-bearing time, as well as VAS scores at 3, 7, and 30 days postoperatively (P<0.05) . All the patients in both groups were followed up for more than 12 months, and the revision surgery of total hip arthroplasty was performed in 1 case only (1.56%) in the FNS group, whereas 2 cases (2.7%) in the CS group. The Harris score, flexion-extension and internal-external rotation range of motions of the hip (ROMs) increased significantly in both groups over time postoperatively (P<0.05) , which in the FNS group proved significantly superior to those in the CS group at all corresponding time points (P<0.05) . With respect to radiographic evaluation, although there were no signifi- cant differences in term of Garden index, neck shortening and neck-shaft angle between the two groups immediately postoperatively (P> 0.05) , the FNS group proved significantly superior to the CS group in terms of radiographic fracture healing time, as well as femoral neck shortening, neck-shaft angle and internal fixation loosening at the latest follow up (P<0.05) . [Conclusion] The FNS has an advantage of firm fixation of the fracture, which facilitates fracture healing and functional recovery for femoral neck fractures in young and middle-aged over the CS.

Key words:femoral neck fracture; internal fixation; femoral neck system; cannulated screw