空心加压螺钉与股骨颈锁定接骨板治疗中青年股骨颈GardenⅠ、Ⅱ骨折的临床疗效

Clinical Analysis of Cannulated Compression Screws and Femoral Neck Locking Plate in the Treatment of GardenⅠ,Ⅱ Femoral Neck Fractures in Young and Middle-Aged Patients

目的比较空心加压螺钉与股骨颈锁定接骨板治疗中青年股骨颈GardenⅠ、Ⅱ骨折的临床疗效。方法选取2015年8月至2016年8月青海省中医院创伤骨科收住的中青年股骨颈骨折GardenⅠ、Ⅱ患者50例,根据手术方式不同分为空心加压螺钉组和股骨颈锁定接骨板组,各25例。比较两组患者术中情况(手术时间、出血量、透视次数),术后情况(术后第1日血红蛋白、住院时间、开始负重时间、部分负重时间、完全负重时间、骨折愈合时间),以及术后3个月、12个月髋关节Harris评分,并发症发生情况等。结果股骨颈锁定接骨板组手术时间长于空心加压螺钉组[(60.52±5.61)min比(46.52±7.63)min],术中出血量多于空心加压螺钉组[(56.44±4.80)m L比(20.96±3.75)mL],术中透视次数少于空心加压螺钉组[(13.00±2.81)次比(18.44±4.23)次](P<0.01)。股骨颈锁定接骨板组术后第1日血红蛋白水平低于空心加压螺钉组,住院时间长于空心加压螺钉组,术后开始负重时间、部分负重时间、完全负重时间、骨折愈合时间短于空心加压螺钉组(P<0.01)。两组术后3个月、12个月髋关节Harris评分、并发症发生率比较差异无统计学意义(P>0.05)。结论两组12个月后随访髋关节功能均获得良好的疗效,股骨颈锁定接骨板组患者可早期负重,骨折愈合时间较快。

Objective To compare the clinical curative effect of cannulated compression screw and femoral neck locking plate for young and middle-aged patients with Garden Ⅰ , Ⅱ femoral neck fracture. Methods From Department of Orthopedics of Qinghai TCM Hospital during Aug. 2015 and Aug. 2016 50 young and middle-aged patients with Garden Ⅰ , Ⅱ femoral neck fracture were included in the study, and were divided into a cannulated compression screw group and a femoral neck locking plate group with 25 cases each. The intraoperative condition （ operation time, blood loss, X-ray number）, and the postoperative condition （the first postoperative day hemoglobin, the hospitalization days, starting load time, partial load time, full load time, fracture healing time）, and Harris hip score, complications at postoperative 3 months, 12 months of the two groups were compared. Results The operation time of the femoral neck locking plate group was significantly longer than that of the cannulated compression screw group [ （60.52 ± 5.61 ） min vs （46.52 ± 7.63 ） min ], intraoperative blood loss was significantly higher than that of the cannulated compression screw group [ （56.44 ± 4.80） mL vs （ 20.96 ±3.75 ） mL], the number of intraoperative fluoroscopy was significantly lower than that of the cannulated compression screw group [ （ 13. 00 ± 2.81 ） times vs （ 18.44± 4.23 ） times ] （ P 〈0.01 ）. The postoperative 1 day hemoglobin level of the femoral neck locking plate group was significantly higher than that of the cannulated compression screw group, hospi- talization days was significantly longer than of the cannulated compression screws group, the postoperative began to load time,partial weight-bearing time, full load time, fracture healing time was significantly shorter than those of the cannulated compression screw group（P 〈 0.01 ）. There was no statistically significant difference between the two groups in Harris score and complication incidence 3 months, 12 months after the surgery（P 〉 0.05）. Conclusion Both the cannulated compres- sion screw and femoral neck locking plate can achieve good effect with regards to hip function at 12 months follow-up,while patients in the femoral neck locking plate group have early weight bearing, and faster fracture healing.