空心螺钉强斜低位与非强斜低位固定治疗老年股骨颈骨折的疗效比较

Oblique and non-oblique cannulated screwing for senile femoral neck fractures： a comparative study

目的 比较闭合复位空心螺钉强斜低位与非强斜低位固定治疗老年股骨颈骨折的临床疗效.方法 回顾性分析2007年6月至2013年10月期间采用闭合复位空心螺钉内固定治疗的189例老年股骨颈骨折患者资料,根据空心螺钉固定方式的不同分为两组：强斜低位固定组130例,男43例,女87例;平均年龄为（77.8±7.5）岁;骨折Garden分型：Ⅰ、Ⅱ型40例,Ⅲ、Ⅳ型90例;其中PauwellsⅢ型骨折26例.非强斜低位固定组59例,男24例,女35例;平均年龄为（75.5±8.2）岁;骨折Garden分型：Ⅰ、Ⅱ型12例,Ⅲ、Ⅳ型47例;其中PauwellsⅢ型骨折15例.比较两组患者的骨折愈合率、术后并发症发生率、再手术率及末次随访时髋关节Harris评分等. 结果 189例患者术后获10 ～38个月（平均17.4个月）随访.强斜低位固定组患者的骨折愈合率[99.2％ （129/130）]、内固定失效率[3.1％（4/130）]及股骨头缺血性坏死率[2.3％ （3/130）]与非强斜低位固定组[98.3％ （58/59）、10.2％ （6/59）、5.1％ （3/59）]比较差异均无统计学意义（P＞0.05）.但强斜低位固定组患者的颈短缩率[35.4％ （46/130）]及再手术率[3.1％ （4/130）]显著低于非强斜低位固定组[50.8％ （30/59）、15.3％ （9/59）],而末次随访时髋关节Harris评分[（75.7±14.3）分]显著高于非强斜低位固定组[（70.8±16.7）分],差异均有统计学意义（P＜0.05）. 结论 闭合复位空心螺钉强斜低位固定治疗老年股骨颈骨折,可以在一定程度上降低颈短缩率及再手术率,有利于髋关节功能的恢复,其疗效优于非强斜低位固定.

Objective To compare the clinical outcomes between oblique and non-oblique fixation with cannulated screws for femoral neck fractures in the elderly patients.Methods Totally 189 patients of over 65 years old were treated for femoral neck fracture from June 2007 to October 2013 at our department.Oblique fixation with cannulated screws was used in 130 cases.They were 43 males aud 87 females with an average age of 77.8 ± 7.5 years.According to Garden classification,40 cases were of Garden types Ⅰ and Ⅱ （undisplaced fractures）,and 90 of Garden types Ⅲ and Ⅳ （displaced fractures）.Of them 26 were Pauwells type Ⅲ.Non-oblique fixation with cannulated screws was conducted in 59 cases.They were 24 males and 35 females with an average age of 75.5 ± 8.2 years.According to Garden classification,12 cases were of Garden types Ⅰ and Ⅱ （undisplaced fractures）,and 47 of Garden types Ⅲ and Ⅳ （displaced fractures）.Of them,15 were Pauwells type Ⅲ.The fracture union,postoperative complications,rate of reoperation and Harris scores at the last follow-up were compared between the 2 groups.Results All the 189 patients were followed up for 10 to 38 months （average,17.4 months）.The oblique fixation led to a union rate of 99.2% （129/130）,a fixation failure rate of 3.1% （4/130） and a femoral head necrosis rate of 2.3% （3/130）,which were not significantly different from those resulted from the non-oblique fixation [98.3% （58/59）,10.2% （6/59） and 5.1% （3/59） respectively] （P 〉 0.05）.However,the rate of femoral neck shortening [35.4% （46/130）] and the reoperation rate [3.1% （4/130）] in the oblique fixation group were significantly lower than those in the non-oblique fixation group [50.8% （30/59） and 15.3% （9/59） respectively] （P 〈 0.05）.The mean Harris hip score at the last follow-up for the oblique fixation（75.7 ± 14.3） was significantly higher than that for the non-oblique fixation （70.8 ± 16.7） （P 〈 0.05）.Conclusion As oblique cannulated screwing can reduce the rates of femoral neck shortening and reoperation to some extent,it may be a better fixation choice than the non-oblique cannulated screwing for femoral neck fracture in elderly patients.