动力髋螺钉加防旋螺钉与3枚空心螺钉治疗股骨颈粉碎性骨折的疗效比较

Comparison among three cannulated screws and dynamic hip screw combined with antirotation screw for comminuted fractures of femoral neck

目的 ：比较3枚空心螺钉与动力髋螺钉（dynamic hip screw,DHS）加防旋螺钉治疗股骨颈粉碎性骨折的临床疗效。方法：自2008年1月至2012年12月,治疗股骨颈粉碎性骨折67例,根据不同内固定方式分为两组,其中36例采用DHS加防旋螺钉固定治疗（DHS组）,男24例,女12例,年龄22~58岁,平均43.7岁;31例采用3枚空心螺钉固定治疗（空心钉组）,男22例,女9例,年龄24~56岁,平均43.0岁。观察并比较两组患者切口大小、手术时间、术中出血量、输血率、术后住院时间、下地行走与患肢负重时间、骨折愈合时间、并发症发生率,采用髋关节Harris评分对两组患者的功能进行比较。结果：两组患者术后切口均Ⅰ期愈合。两组手术时间、术中出血量、术中输血率及术后住院时间比较,差异无统计学意义（P〉0.05）。切口长度：DHS组（5.00±0.86）cm,空心钉组（3.30±0.57）cm,两组比较差异有统计学意义（P〈0.01）。所有患者获1年以上随访,两组随访时间差异无统计学意义（P〉0.05）。术后下地行走时间：DHS组为（19.0±3.5）d,空心钉组为（37.0±6.3）d,差异有统计学意义（P〈0.01）。患肢部分负重时间和完全负重时间：DHS组分别为术后（23.0±7.0）d、（138.0±13.0）d,空心钉组分别为术后（38.0±5.7）d、（164.0±12.0）d,差异均有统计学意义（P〈0.01）。骨折愈合时间：DHS组为（151±11）d,空心钉组为（162±11）d,差异有统计学意义（P〈0.01）。末次随访时髋关节Harris评分：DHS组为（91.0±5.7）分;空心钉组为（85.0±12.0）分,差异有统计学意义（P〈0.01）。两组术后并发症比较,差异无统计学意义（P〉0.05）。结论：对于股骨颈粉碎性骨折的治疗,DHS联合防旋螺钉优于3枚空心螺钉固定,具有术后患肢负重更早,骨折愈合更快,髋关节功能更好的优点。

Objective ：To compare the effect of three cannulated screws and dynamic hip screw （DHS） combined with antirotation screw in treating patients with comminuted fractures of femoral neck. Methods： From January 2008 to December 2012,67 patients with comminuted fractures of femoral neck were treated with three cannulated screws or DHS combined with antirotation screw. Among them, 36 patients were treated with DHS combined with antirotation screw including 24 males and 12 females with an average of 43.7 years old ranging from 22 to 58 years old; 31 patients were treated with three cannulated screws including 22 males and 9 females with an average of 43.0 years old ranging from 24 to 56 years old. The incision size, operation time, blood loss, blood transfusion rate, postoperative hospital stay, walking time, weight-bearing time, union time, incidence of complication were recorded and compared between two groups, and functional outcomes were evaluated by Harris scoring. Results：All incision healed at stage I. The differences in operation time, blood loss, blood transfusion rate and postoperative hospital stay between two groups were not significant （P〉0.05）. Incision size of DHS group （5.00±0.86） em was larger than that of cannulated screw group （3.30±0.57） cm （P〈0.01）. All patients were followed up more than one year, and the fol- low-up time showed no significant difference between two groups （P〉0.05）. Walking time of DHS group （ 19.0±3.5 ） d was less than that of cannulated screw group （37.0±6.3） d （P〈0.01. Partial and full weight-bearing time of DHS group （23.0±7.0） d and （138.0±13.0） d was less than that of cannulated screw group （38.0±5.7） d and （164.0±12.0） d （P〈0.01）. Union time of DHS group （ 151±11 ） d was less than that of cannulated screw group （162±11） d （P〈0.01）. Harris hip score of DHS group （91.0± 5.7） was higher than that of cannulated screw group （85.0±12.0） （P〈0.01 ）. No significant differences were found in the inci- dence of postoperative complications between two groups （P〉0.05）. Conclusion：The DHS combined with antirotation screw is superior to three cannulated screws for treatment of comminuted fractures of femoral neck due to earlier weight-bearing, faster fracture healing and better hip function