股骨颈系统与空心螺钉固定股骨颈骨折的比较△

Femoral neck system versus cannulated screws for fixation of femoral neck fractures

摘要:

[目的] 比较股骨颈系统（femoral neck system, FNS） 与传统3 枚空心加压螺钉（cannulate compression screw, CCS）治疗中青年股骨颈骨折患者的临床效果。[方法] 回顾性分析2019 年11 月—2020 年6 月内固定治疗94 例股骨颈骨折患者的临床资料。根据医患沟通结果，46 例采用FNS，48 例采用CCS。比较两组围手术期、随访及影像结果。[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，FNS 组手术时间、术中出血量、术中透视次数和住院时间显著优于CCS 组。两组患者随访（15.5±1.6） 个月。FNS 组恢复完全负重活动时间显著早于CCS 组（P＜0.05）。随时间推移，两组Harris 评分、髋伸-屈ROM、髋内-外旋ROM 均显著增加（P＜0.05），VAS 评分显著减少（P＜0.05）；术后1 个月FNS 组上述指标均显著优于CCS 组，术后6 个月和末次随访两组间上述指标的差异均无统计学意义（P＞0.05）。影像方面，与术前相比，术后两组Garden对线指数均显著改善（P＜0.05），相应时间点，两组Garden 对线指数的差异无统计学意义（P＞0.05）。术后6 个月及末次随访时，FNS 组股骨颈短缩显著少于CCS 组（P＜0.05）。两组影像骨折愈合的差异无统计学意义（P＞0.05）。相应时间点，FNS 组固定效果和稳定性显著优于CCS 组（P＜0.05）。随术后时间延长，两组髋关节均有一定程度退变，但相应时间点，两组Tonnis 分级的无差异无统计学意义（P＞0.05)。[结论] 相比于传统CCS 内固定方式，FNS 手术创伤小、稳定性强，术后髋关节功能恢复更好。

Abstract:

[Objective] To compare the clinical outcomes of femoral neck system (FNS) versus traditional 3 cannulated compressionscrews (CCS) for femoral neck fractures in the young and middle-aged. [Methods] A retrospective study was done on 94 patients who re-ceived internal fixation for femoral neck fractures from November 2019 to June 2020. According to doctor-patient communication, 46 pa-tients had fractures fixed with FNS while the remaining 48 patients were treated with CCS. The perioperative, follow-up and imagingdocumants were compared between the two groups. [Results] All patients in both groups had operation finished successfully without any se-rious complications, such as neurovascular injury. The FSN group proved significantly superior to the CCS group in terms of operation time,intraoperative blood loss, intraoperative fluoroscopy and hospital stay (P＜0.05). All of them in both groups were followed up for (15.5±1.6)months on an average, and the FNS group returned to full weight-bearing activity significantly earlier than the CCS group (P＜0.05). TheHarris score, hip extension-flexion range of motion (ROM) and internal-external rotation ROM significantly increased (P＜0.05), while theVAS score significantly decreased in both groups over time (P＜0.05), which in the FNS group were significantly better than the CCS groupone month after surgery (P＜0.05), and became not statistically significant between the two groups at 6 months after surgery and the latest fol-low-up (P＞0.05). Radiographically, Garden alignment index significantly improved in both groups postoperatively compared with that be-fore operation (P＜0.05), which proved not significantly different between the two groups at any time points accordingly (P＞0.05). At 6months and the latest follow-up, femoral neck shortening in the FNS group was significantly less than those in the CCS group (P＜0.05), al-though there was no significant difference in fracture healing time between the two groups (P＞0.05). At the time points accordingly, the fixa-tion stability in FNS group were significantly better than that in CCS group (P＜0.05). With time postoperatively hip degeneration in some extent was noted in both groups, but which was not significantly different in term of Tonnis classification between the two groups at any cor-responding time points (P＞0.05). [Conclusion] Compared with traditional CCS internal fixation, FNS is less invasive, more stable, and getsbetter hip function recovery after surgery.