两种内固定治疗青中年股骨颈骨折的比较

Comparison of two kinds of internal fixation for femoral neck fracture in young and middle-aged

摘要:

［目的］ 比较股骨颈动力交叉钉系统 （femoral neck system, FNS） 与 4 枚空心加压螺钉 （cannulate compression screw, CS） 两种内固定方式治疗股骨颈骨折的长期临床疗效。［方法］ 2018 年 9 月—2021 年 6 月，45 例股骨颈骨折患者纳入本研究。依据医患沟通结果，22 例采用 FNS 内固定，23 例采用 CS 内固定。比较围手术期、随访和影像资料。［结果］所有患者均顺利完成手术。FNS 组在手术时间 [(54.6±18.0)min vs (84.3±33.3)min, P=0.001]、术中透视次数显著小于 CS 组 [(17.3±4.2)次 vs (24.3±6.3)次, P<0.001]，但 FNS 组切口长度 [(5.4±0.6)cm vs (4.6±0.7)cm, P<0.001]、术中失血量 [(132.4±50.9)ml vs (47.0±15.7)ml, P< 0.001] 显著大于 CS 组。所有患者均获随访 15~46 个月，平均 （29.5±15.2） 个月。FNS 组恢复完全负重活动显著早于 CS 组 [(5.5±1.2)个月 vs (7.7±4.2) 个月, P=0.029]。随时间推移，两组 Harris 评分、髋伸-屈 ROM 和髋内旋-外旋 ROM 均显著增加 （P< 0.05）。至末次随访时，FNS 组晚期不良事件，包括内固定物切出、股骨颈短缩、骨不连、股骨头坏死的发生率显著低于 CS 组 [7/22 (31.8%) vs 15/23 (65.2%), P=0.027]。FNS 组的全髋置换翻修率低于 CS 组，但差异无统计学意义 [4/22 (18.2%) vs 8/23 (34.8%), P=0.563]。影像方面，与术前相比，末次随访时两组 Garden 指数均显著改善（P<0.05）。至末次随访时，FNS 组不良影像改变发生率显著低于 CS 组 （P<0.05）。随时间推移，两组髋退变 Tonnis 分级均有加重趋势，但差异无统计学意义 （P> 0.05）。［结论］FNS 固定青中年人股骨颈骨折在骨折愈合和晚期不良事件发生率明显优于 CS。

Abstract:

[Objective] To compare the long-term clinical outcomes of femoral neck system (FNS) versus four cannulate compression screws (CS) for femoral neck fracture. [Methods] From September 2018 to June 2021, a total of 45 patients with femoral neck fracture were included in this study. According to doctor-patient communication, 22 patients received FNS internal fixation, while the remaining 23 pa- tients underwent CS internal fixation. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups had corresponding surgical procedures performed successfully. The FNS group was significantly less than the CS group in terms of operative time [(54.6±18.0)min vs (84.3±33.3)min, P=0.001] and intraoperative fluoroscopy times [(17.3±4.2)times vs (24.3±6.3)times, P＜0.001], whereas the former was significantly greater than the latter in terms of incision length [(5.4±0.6)cm vs (4.6±0.7) cm, P＜0.001] and intraoperative blood loss [(132.4±50.9)ml vs (47.0±15.7)ml, P＜0.001]. All patients were followed up for 15~46 months, with a mean of (29.5±15.2)months. The FNS group returned to full weight-bearing activity significantly earlier than the CS group [(5.5±1.2) months vs (7.7±4.2)months, P=0.029]. The Harris score, hip extension-flexion ROM and hip internal-rotation ROM were significantly in- creased in both groups over time (P＜0.05). By the latest follow-up, the FNS group had significantly lower incidence of late adverse events, including internal fixation displacement, femoral neck shortening, fracture nonunion, and femoral head necrosis, than the CS group [7/22 (31.8%) vs 15/23 (65.2%), P=0.027]. The former had low rate of total hip replacement revision than the latter, despite of that the difference was not statistically significant [4/22 (18.2%) vs 8/23 (34.8%), P=0.563]. In terms of imaging, Garden index was significantly improved in both groups at the last follow-up compared with the preoperative period (P＜0.05). At the last follow-up, the FNS group got significantly low- er incidence of adverse imaging changes than the CS group (P＜0.05). The Tonnis grade of hip degeneration tended to increase over time in both groups, but the difference was not statistically significant (P＞0.05). [Conclusion] The FNS used as internal fixation for femoral neck fracture in young and middle-aged does considerably be superior to the CS regarding fracture healing and late adverse events.