多方向空心钉内固定对股骨颈骨折术后颈短缩的控制

Cannulated screw multi- directional fixation strategy for resisting femoral neck shortening after fracture

[目的]探讨股骨颈骨折多方向空心钉内固定术对股骨颈短缩的影响。[方法]2009年6月~2013年5月,采用闭合复位空心钉内固定术治疗186例中老年股骨颈骨折,年龄55~65岁,将患者随机分为两组,传统平行固定组及多方向固定组。[结果]术后155例患者获得随访,其中平行组患者股骨颈短缩率32.8%,多方向组16.4%,两组比较差异有统计学意义（P〈0.05）;传统平行组患者股骨骨折愈合率91.8%,多方向组89.6%,两组比较差异无统计学意义（P〉0.05）;传统平行组术后髋关节Harris评分（70.58±6.85）分;多方向固定组术后髋关节Harris评分（91.69±8.34）分,传统平行组Harris评分低于多方向固定组,差异有统计学意义（P〈0.05）;平行组术后2年股骨头坏死率44.3%;多方向固定组术后2年股骨头坏死率26.9%,差异有统计学意义（P〈0.05）。[结论]股骨颈骨折空心钉多方向固定较传统平行固定在有效降低股骨颈短缩率的同时,可更大程度的保护髋关节功能、降低股骨头坏死率。

[ Objective ] To explore the resisting effect of femoral neck shortening after cannulated screw multi - dlrectional fixation. [ Method] From June 2009 to May 2013,186 adult patients with femoral neck fracture were treated with closed reduction and cannulated screw fixation. The patients included 87 males and 99 females, and the age at the time of surgery ranged from 55 to 65 years. All cases were randomly divided into traditional parallel cannulated screws fixation group （ n = 90 cases ） and multi - directional fixation group （ n = 96 cases）. Postoperatively, Garden index was used to evaluate the reduction and Harris scoring system was applied to assess the functional recovery. Results were compared between two groups by using statistical a- nalysis. [ Result] Thirtyone patients were lost to follow -up, the remaining 155 patients received followed up for this study. The femoral neck shortening rate was 32.8% in parallel fixation group, and was 16.4% in multi - directional fixation group, the difference had statistical significance between the two groups （P 〈 0.05 ）. The fracture healing rate was 91.8% in parallel fixation group, and was 89.6% in multi - directional fixation group, without statistically significant difference （ P 〉 0.05 ）. Harris score was （ 70.58 ±6.85 ） points in parallel fixation group, but in multi - directional fixation group, it was （ 91.69 ±8.34） points, showing significant difference （P 〈 0.05 ）. The rate of osteonecrosis at 2 years after surgery was 44.3% in parallel fixation group, and was 26.9% in multi -directional fixation group, with significant difference as well（ P 〈0. 05 ）. [ Conclusion ] Compared with traditional parallel fixation , multi - directional fixation can reduce the femoral neck shortening rate, protect the hip function recovery as well as decrease the osteonecrosis rate.