空心钉复合内侧支撑钢板固定Pauwels III型股骨颈骨折

Cannulated screw combined with medial buttress plate for internal fixation of Pauwels type III femoral neck fractures

摘要:

［目的］ 探讨空心钉复合内侧支撑钢板固定 Pauwels Ⅲ型股骨颈骨折的临床疗效。［方法］ 回顾分析 2015 年 1 月— 2021 年 6 月收治的 72 例 Pauwels Ⅲ型股骨颈骨折患者的临床资料。依据术前医患沟通结果，33 例采用 3 枚空心钉复合内侧支撑钢板固定（复合组），39 例采用单纯 3 枚空心钉固定（空心钉组）。比较两组围手术期、随访以及影像资料。［结果］两组患者均顺利完成手术，术中无严重并发症。复合组的手术时间、术中出血量显著大于空心钉组 （P<0.05），但是两组间切口总长度、术中透视次数、导针定位次数、下地行走时间、切口愈合情况、住院时间的差异均无统计学意义 （P>0.05）。所有患者均获随访 12~24 个月，复合组恢复完全负重活动显著早于空心钉 （P<0.05）。复合组 33 例中，均未发生骨不连接、股骨头坏死； 空心钉组 39 例中，骨不连接 3 例，股骨头坏死 2 例，复合组晚期并发症发生率明显小于空心钉组 （P<0.05），随术后时间推移，两组患者 Harris 评分、髋伸-屈 ROM、髋内旋-外旋 ROM 均显著增加 （P<0.05）。术后所有相应时间点，复合组的 Harris 评分、髋伸-屈 ROM、髋内旋-外旋 ROM 均显著优于空心钉组（P<0.05）。影像方面，末次随访时，复合组 Garden 指数、颈干角和 Tonnis 分级均显著优于空心钉组（P<0.05）。［结论］空心钉复合内侧支撑钢板固定 Pauwels Ⅲ型股骨颈骨折的临床疗效明显优于单纯空心钉固定。

Abstract:

[Objective] To evaluate the clinical outcome of cannulated screw combined with medial buttress plate (CSBP) for internalfixation of Pauwels type III femoral neck fractures. [Methods] A retrospective study was conducted on 72 patients who received open reduc-tion and internal fixation (ORIF) for Pauwels type Ⅲ femoral neck fractures from January 2015 to June 2021. According to the results ofpreoperative doctor- patient communication, 33 patients underwent CSBP, while the remaining 39 patients had conventional cannulatedscrew (CS) performed. The documents regarding perioperative period, follow-up and radiographs were compared between the two groups.[Results] All patients in both groups had corresponding surgical procedures performed smoothly without serious complications. Althoughthe CSBP group consumed significantly longer operation time, associated with significantly more intraoperative blood loss than the CS group(P＜0.05) , there were no significant differences between the two groups in terms of the total incision length, intraoperative fluoroscopytimes, guide needle placing times, ambulation time, incision healing, and hospital stay between the two groups (P＞0.05) . All patients werefollowed up for 12~24 months, and the CSBP group returned to full weight- bearing activity significantly earlier than the CS group (P＜0.05) . In the CSBP group, there was no bone nonunion or femoral head necrosis. Among the 39 cases in the CS group, there were 3 cases ofbone nonunion and 2 cases of femoral head necrosis. The incidence of late complications in the CSBP group was significantly lower thanthat in the CS group (P＜0.05) . The Harris score, hip extension -flexion range of motion (ROM) , and hip internal-external rotation ROM in-creased significantly over time postoperatively in both groups (P＜0.05) . The CSBP group proved significantly superior to the CS group interms of Harris score, hip extension- flexion ROM, and hip internal-external rotation ROM at all time points postoperatively (P＜0.05) .With respect of radiographic evaluation, the CSBP group was significantly superior to the the CS group in terms of Garden index, neckshaft angle, and Tonnis grade for hip degeneration at the latest follow-up (P＜0.05) . [Conclusion] This cannulated screw combined with me-dial buttress plate for internal fixation of Pauwels type Ⅲ femoral neck fractures does achieve considerably better clinical outcomes than the cannulated screw only.