多枚空心钉与空心钉锁定钢板治疗中青年股骨颈骨折的比较研究

Comparatives tudy of femoral neck fractures treating with multiple hollow screws and hollow nail locking plate in young and middle age people

目的：比较多枚空心钉与空心钉锁定钢板治疗中青年股骨颈骨折的临床疗效。方法：回顾2011年1月～2014年6月期间东莞市厚街医院收治的符合该项研究标准的91例股骨颈骨折患者。其中45例患者为采用多枚空心钉内固定治疗（空心钉组），46例患者为采用空心钉锁定钢板治疗（锁定钢板组）。对2组患者一般资料的比较，差异无统计学意义（P＞0．05），具有可比性。然后对2组组患者的术中情况、术后骨折愈合、发生早期内固定物断裂、脱出或松动及术后髋部功能恢复情况进行比较，其中髋部功能恢复情况用Harris髋关节评分进行比较。结果：空心钉组股骨颈骨折愈合率为80．00％（36／45），锁定钢板组股骨颈骨折愈合率为86．95％（40／46）；空心钉组发生股骨头坏死率为8．89％（4／45），锁定钢板组发生股骨头坏死率为2．17％（1／46）；空心钉组发生骨不愈合率为15．56％（7／45），锁定钢板组发生骨不愈合率为10．86％（5／46）。以上各结果的比较，2组患者差异均无统计学意义（P＞0．05）。空心钉组出现早期螺钉松动、退钉、断钉的发生率为26．67％（12／45）；锁定钢板组出现早期螺钉松动、退钉、断钉的发生率为6．52％（3／46），2组患者差异有统计学意义（ P＜0．05）。将患者按照Pauwels分型方法进行分型，比较2组患者各分型间发生早期内固定物断裂、脱出或松动的情况，在2组患者中，PauwelsⅠ型、Ⅱ型差异无统计学意义（ P＞0．05），PauwelsⅢ型患者之间差异有统计学意义（P＜0．05）。术后6个月随访Harris髋关节评分：空心钉组85．2±7．98分，空心钉锁定钢板组87．4±8．31分，2组患者差异无统计学意义（P＞0．05）。结论：多枚空心钉和空心钉锁定钢板内固定均为治疗中青年股骨颈骨折的安全、可靠的手术方法，运用于合适的患者中（如颈干角、股骨颈直径大小合适、PauwelsⅡ、Ⅲ型的患者中），空心钉锁定钢板内固定治疗股骨颈骨折是一种比单纯多枚空心钉内固定更安全、可靠的手术方法，比3枚空心钉内固定治疗中青年股骨颈骨折有着更低的早期螺钉松动、退钉、断钉、股骨头旋转、髋内翻、髋外翻、短缩畸形等情况的发生率的优点；多枚空心钉有着软组织损伤更小、出血量更少、手术时间更短、治疗费用更低的优点。

Objective：To compare the clinical efficacy of the hollow screw locking plate and the hollow compression screw for treating femoral neck fracture in young adults.Methods：Back in January 2011 to June 2014 period Dongguan Houjie hospital admitted to conform to the standard of the study of 91 cases of femoral neck fracture patients.45 patients were treated with multiple hollow screws internal fixa-tion （ Group hollow screws） , and 46 patients were treated with hollow screw locking plate （ Group locking plate） .The general data of the two groups of patients were compared, the difference was not statistically significant （P〉0.05）, with comparability（shown in Table 1）. And the situation in operation of two groups of patients, postoperative fracture healing and early internal fixation fracture, dislocation or loosening, postoperative hip function recovery were compared, which hip function recovery with Harris hip score were compared.Results：The fracture healing rate of femoral neck fracture in the Group hollow nail was 80%（36/45）, and the healing rate of femoral neck frac-ture in the Group locking plate was 86.95%（40/46）;The femoral head necrosis rate in the Group hollow nail was 8.89%（4/45）, and the incidence of femoral head necrosis in the Group locking plate was 2.17%（1/46）;The rate of bone nonunion in the Group hollow nail was 15.56%（7/45）,the rate of nonunion of Group locking plate was 10.86%（5/46）.there was no significant difference between the comparison of these results of the two groups （P〉0.05）.The rate of happenning early loosening of the screws, screw withdrawal, nail broken in the Group hollow nail was 26.67%（12/45） ;The rate in Group locking plate was 6.52%（3/46）, the difference between two groups has statistical significance （P〈0.05）.The patients were classified according to the Pauwels typing method,the rates of happenning early fixation fracture, dislocation or loosening were compared between the two groups of each type.In the two groups, there was no signifi-cant difference in Pauwels I and II （P〉0.05）, and the difference was statistically significant （P〈0.05） between patients with type Pau-wels III.The Harris hip score of last following up：Group locking plate was （85.2 ±7.98） score,Group locking plate was （87.4 ±8. 31）score,the difference was not statistically significant （P〉0.05） between the two groups.Con clusion：Both the internal fixation with multiple hollow screws and with the hollow screw locking plate were the safe and reliable operation method for the treatment of femoral neck fractures in young and middle-aged people.Use in appropriate patients （ such as patients with appropriate neck stem angle, femoral neck diameter size, Pauwels II, III type ） ,internal fixation with cannulated screw locking plate for treatment of femoral neck fractures should be more safe and reliable than simple cannulated screw internal fixation, had a lower rate of happenning early loosening of the screws, nails back,broken nails , femoral head rotation, varus deformity of the hip, hip valgus, short deformity;Multiple hollow screws have the advan-tages of less soft tissue damage, less bleeding, shorter operation time and lower cost of treatment.