三枚和四枚空心钉内固定治疗股骨颈骨折的比较研究

Three and four cannulated screw fixation in treatment of femoral neck fractures: a comparative study

目的通过回顾性对照研究,比较3枚空心钉和4枚空心钉内固定治疗股骨颈骨折的疗效。方法共54例股骨颈骨折,3枚空心钉内固定组31例,4枚空心钉内固定组23例。统计分析两组间的并发症发生率和髋关节功能Harris评分。结果 54例均获平均35(14～72)个月随访。3枚空心钉内固定组有2例(6.5%)内固定失败和3例(9.7%)股骨头坏死,Harris评分平均(84±13)分,优良率74%;4枚空心钉内固定组有2例(8.7%)股骨头坏死,Harris评分平均(86±10)分,优良率78%。两组间并发症发生率及Harris评分差异无统计学意义(P>0.05)。结论闭合复位空心钉内固定是治疗股骨颈骨折的有效方法,3枚或4枚空心钉内固定均可取得较好的治疗效果;4枚空心钉内固定可以较好地对抗剪切应力,避免早期内固定失败。

Objective To retrospectively compare the functional outcomes and complications of three and four cannulated screw fixation in treatment of femoral neck fractures. Methods A total of 54 patients were included, the three screw group contained 31 patients, and the four screw group contained 23 patients. The complication rate and Harris scores were recorded and compared. Results The mean follow-up of our patients was 35 months （range 14 to 72 months）. A total of 2 internal fixation failures（6.5%） and 3 femoral head avascular necrosis（9.7%） were found in three screw group; The mean Harris score was （84~13）points, with a excellent and good rate of 74%. Two femoral head avascular necrosis （8.7%） were found in four screw group; The mean Harris score was （86~10）points, with a excellent and good rate of 78%. No significant difference was found between the two treatment groups （P 〉0.05）. Conclusion Closed reduction and cannulated screw internal fixation of femoral neck fracture is a good treatment method, and both three and four screw fixation could reach good results. Furthermore, four screw fixation could reduce the shear stress, prevent the earlier failure of internal Frxation.