两种方法治疗Pauwels Ⅲ型股骨颈骨折的疗效对比

Comparison of Two Methods in the Treatment of Pauwels Type Ⅲ Femoral Neck Fractures

目的比较空心钉加内侧支撑钢板与单纯空心钉内固定治疗PauwelsⅢ型股骨颈骨折的临床疗效。方法按入组标准选取2016年10月至2017年4月在我院治疗的60例PauwelsⅢ型股骨颈骨折患者,其中男41例,女19例;年龄18~52岁,平均(35.50±8.678)岁。按随机数字表法随机分为试验组和对照组,每组30例。试验组采用空心钉加内侧支撑钢板的方法治疗,对照组采用单纯空心钉治疗。对两组术中出血量、手术时间、复位质量、术后骨折愈合时间、股骨头坏死与骨折不愈合等并发症的发生情况及术后6个月Harris评分进行对比。结果对照组出血量(59.8±10.1)mL,低于试验组(150.5±28.2)mL;对照组手术时间(46.5±8.110)min,低于试验组(73.0±7.834)min;试验组骨折愈合时间(4.33±0.884)个月,低于对照组(5.48±1.312)个月;差异均具有统计学意义(P<0.05)。两组在骨折复位质量和内固定失效例数方面比较,差异有统计学意义(P<0.05),试验组优于对照组;两组骨不连和股骨头坏死情况比较差异无统计学意义(P>0.05)。试验组术后6个月Harris评分为(88.37±3.211)分,高于对照组(82.47±6.627)分,差异具有统计学意义(P<0.05)。结论空心钉加内侧支撑钢板治疗PauwelsⅢ型股骨颈骨折效果优于单纯空心内固定,具有骨折复位质量高、愈合时间快、内固定失效率低和髋关节功能恢复好等优点。

Objective To compare the clinical outcomes of hollow screw combined with medial supporting plate and simple hollow screw internal fixation for Pauwels type Ⅲ femoral neck fracture. Methods From October 2016 to April 2017,60 patients with Pauwels type Ⅲ femoral neck fractures,including41 males and 19 females,were randomly divided into experimental group and control group according to the experimental criteria.The experimental group was treated with hollow screws and medial supporting plate.The control group was treated with simple cannulated screws.The following data of the two groups were compared：the blood loss,operation time,reduction quality,the time of fracture healing,the incidence of complications such as femoral head necrosis and nonunion,the Harris score at sixth month. Results The blood loss of the control group （59.8±10.1） mL,was lower than the test group （150.5±28.2） mL （ P 〈0.05）.The operation time of the control group （46.5±8.110） min,was lower than the test group （73.0±7.834） min （ P 〈0.05）.The fracture healing time of the test group （4.33±0.884） months,was lower than the control group （5.48±1.312） months （ P 〈0.05）.The test group was better than the control group in the fracture reduction quality and the number of internal fixation failure cases （ P 〈0.05）.There were no significant differences between the two groups in bone nonunion and femoral head necrosis （ P 〉0.05）.The Harris score of the test group （88.37±3.211） was higher than the control group （82.47±6.627） at sixth month （ P 〈0.05）. Conclusion The outcomes of hollow nail and medial support plate in the treatment of Pauwels type Ⅲ femoral neck fracture is better than that of hollow internal fixation.It has the advantages of high quality of fracture reduction,fast healing time,low internal fixation failure rate and good recovery of hip joint function.