经皮加压钢板、动力髋螺钉、空心螺钉治疗移位型股骨颈骨折的临床观察

Clinical Comparison of Percutaneous Compression Plate,Dynamic Hip Screw and Canulated Screw in Treatment of Displaced Femoral Neck Fracture

目的:对比分析经皮加压钢板(PCCP)、动力髋螺钉(DHS)、空心螺钉治疗移位型股骨颈骨折的临床疗效。方法:以本院2012年1月至2015年10月收治的120例移位型股骨颈骨折患者为研究对象,根据不同内固定方式将其分为PCCP组、DHS组、空心螺钉组,比较三组围手术期指标及术后并发症。术后随访3~18个月,观察比较三组术后3个月及末次随访髋关节功能恢复情况。结果:PCCP组及空心螺钉组手术时间、术中出血量、术后完全负重时间明显少于DHS组,差异有统计学意义(P<0.05),而PCCP组与空心螺钉组上述指标(完全负重时间除外)比较差异无统计学意义(P>0.05)。空心螺钉组术后并发症发生率明显低于DHS组,差异有统计学意义(P<0.05),而明显高于PCCP组,差异有统计学意义(P<0.05)。PCCP组术后3个月髋关节功能恢复优良率72.50%,显著高于DHS组的20.00%、空心螺钉组的48.89%,差异有统计学意义(P<0.05)。三组末次随访髋关节功能恢复优良率比较,差异无统计学意义(P>0.05)。结论:三者术后18个月髋关节功能恢复效果类似,但相比DHS及空心螺钉,PCCP治疗移位型股骨颈骨折并发症少,术后完全负重时间早,早期功能恢复更好,而空心螺钉在并发症、术后早期功能恢复上较DHS有优势。

Objective： To comparatively analyze the clinical effects of percutaneous compression plate （PCCP）, dynamic hip screw （DHS） and canulated screw in the treatment of displaced femoral neck fractures. Methods.. 120 cases of patients with displaced femoral neck fractures who were admitted in our hospital between January 2013 and October 2014 were selected as the study objects. According to the different internal fixation methods, the patients were divided into PCCP group, DHS group and canulated screw group. The perioperative indexes and postoperative complications were compared among the three groups. Patients were followed up for 3~ 18 months after operation. The recovery of hip joint function in 3 months after operation and at the last follow-up was observed and compared among the three groups. Results：The operation time, intraoperative blood loss and postoperative full weight-bearing time of PCCP group and canulated screw group was less than that of DHS group （P〈0.05） while there were no significant differences between PCCP group and canulat- ed screw group in indexes mentioned above （except for full weight-bearing time） （P〈0.05）. The incidence of postoperative complications in canulated screw group was significantly lower than that in DHS group （P〈0.05）, and was significantly higher than that in PCCP group （P〈0.05）. The excellent rate of recovery of hip joint in PCCP group 3 months after operation （72. 50%） was significantly higher than that in DHS group （20. 00%） and cannulated screw group （48.89%） （P〈0.05）. There were no significant differences in the excellent rate of recovery of hip function between the three groups at the last follow-up （P〈0.05）. Conclusion.. The function recovery of hip joint was similar in the three groups18 months after operation. However, compared with DHS group and cannulated screw group, the PCCP group has less complications, early full weight-bearing time and better early functional recovery. Canulated screw has more advantage in complications and postoperative early functional recovery over DHS.