空心钉与股骨颈动力交叉钉系统治疗PauwelsⅡ~Ⅲ型股骨颈骨折的疗效比较

Comparison of efficacy of cannulated compression screws and femoral neck system in treatment of Pauwels typeⅡandⅢfemoral neck fractures

目的探究空心钉(CCS)内固定与股骨颈动力交叉钉系统(FNS)治疗PauwelsⅡ~Ⅲ型股骨颈骨折的疗效。方法选取于本院就诊的84例PauwelsⅡ~Ⅲ型后侧壁粉碎股骨颈骨折患者为研究对象。根据治疗方式不同分为CCS组(n=42)和FNS组(n=42)。比较2组患者围术期指标、随访结果、疼痛情况、Oswestry功能障碍指数(ODI)、日常生活能力、治疗前后炎症指标水平[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、降钙素原(PCT)水平]及术后12个月生活质量评分。采用随机行走模型评价2组患者炎症指标的改善情况。结果FNS组手术时间短于CCS组(P<0.05),切口长度及术中出血量长/多于CCS组(P<0.05);2组患者住院时间、Garden力线指数及辅助复位情况比较差异无统计学意义(P>0.05)。FNS组患者骨折愈合时间、术后部分及完全负重时间、股骨颈短缩长度及程度、颈干角变化、大腿外侧激惹症状发生率均短/小/低于CCS组,末次随访髋关节Harris评分高于CCS组(P<0.05),2组患者股骨头坏死发生率无明显差异(P>0.05)。治疗后,FNS组视觉模拟量表(VAS)评分、ODI评分、IL-6、TNF-α、CRP、PCT水平均低于CCS组(P<0.05),日常生活能力评分、术后12个月生活质量评分高于CCS组(P<0.05)。随机行走模型结果显示,FNS组患者炎症指标较CCS组改善显著(P<0.05)。结论与CCS内固定治疗相比,FNS治疗PauwelsⅡ~Ⅲ型后侧壁粉碎股骨颈骨折的临床效果更好,可缩短手术时间及骨折愈合时间,减轻患者疼痛,缓解炎症反应等。

Objective To explore the clinical effect of cannulated compression screws(CCS)internal fixation and femoral neck system(FNS)in the treatment of Pauwels typeⅡandⅢfemoral neck fractures.Methods A total of 84 patients of Pauwels typeⅡorⅢfemoral neck fracture with posterior comminution treated in our hospital were selected as the research objects.According to different treatment methods,the patients were divided into CCS group(n=42)and FNS group(n=42).The perioperative indicators,follow-up results,pain status,Oswestry disability index(ODI),ability of daily living,levels of inflammatory indicators[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),procalcitonin(PCT)]before and after treatment,and the quality of life score 12 months after operation were compared between the two groups.The random walk model was used to evaluate the improvement of inflammatory indicators in the two groups.Results The operation time of FNS group was shorter than that of CCS group(P<0.05),the incision length and intraoperative blood loss of FNS group were longer or more than those of CCS group(P<0.05).There was no significant difference in hospital stay,Garden index and assisted reduction between the two groups(P>0.05).The fracture healing time,partial and complete weight bearing time after operation,length and degree of femoral neck shortening,neck shaft angle change,and incidence of lateral thigh irritation in FNS group were all shorter/less/lower than those in CCS group,and Harris score of hip joint was higher than that in CCS group at the last follow-up(P<0.05),while there was no significant difference in the incidence of femoral head necrosis between the two groups(P>0.05).After treatment,the visual analogue scale(VAS)score,ODI score,levels of IL-6,TNF-α,CRP and PCT in FNS group were lower than those in CCS group(P<0.05),and the ability of daily living score and quality of life score 12 months after surgery were higher than those in CCS group(P<0.05).The inflammatory indicators of patients in FNS group were significantly improved compared with those in CCS group by random walk model(P<0.05).Conclusion Compared with CCS internal fixation,FNS has a good clinical effect in the treatment of Pauwels typeⅡandⅢfemoral neck fractures with posterior comminution,which can shorten the operation time and fracture healing time,relieve the pain and the inflammation response of patients.