中空加压螺钉与解剖型钢板固定治疗成年股骨颈基底部骨折的疗效比较

Comparison of hollow compression screw and proximal femur anatomic plate in the treatment of femoral neck basal fracture in adult patients

目的探讨成年股骨颈基底部骨折中空加压螺钉与解剖型钢板固定的临床疗效比较。方法 2008年3月—2014年6月武汉大学人民医院骨科收治45例成年股骨颈基底部骨折患者,分别采用中空加压螺钉(21例)及股骨近端解剖型钢板固定(24例)。其中男性19例,女性26例;年龄38～60岁,平均48.7岁;左侧32例,右侧13例;骨折按Garden分型:I型7例,Ⅱ型15例,Ⅲ型13例,IV型10例。对比分析两组手术时间、术中出血量、骨折愈合时间、术后并发症及髋关节Harris评分。结果患者均获20～45个月随访,平均32.4个月。两组患者手术时间及术中出血量比较差异无统计学意义(P>0.05)。中空加压螺钉固定组中4例于术后1～3个月内固定失效,其中2例行伤肢骨牵引制动3个月后骨折愈合,2例骨折不愈合,二期行内固定翻修术;股骨近端解剖钢板固定组1例术后2个月螺钉松动,髋内翻位愈合,1例术后8个月出现髋关节异位骨化,两组术后并发症比较差异无统计学意义(P>0.05)。中空加压螺钉固定组骨折愈合时间为(16.8±1.7)周,明显长于解剖钢板固定组(14.3±2.5)周,差异有统计学意义(P<0.01)。末次随访时髋关节功能按Harris评定标准评价:中空加压螺钉组优11例,良5例,可2例,差3例,优良率为76.2%;股骨近端解剖型钢板组优19例,良3例,可2例,优良率为91.7%。两组术后髋关节Harris评分比较差异有统计学意义(P<0.05)。结论 GardenⅢ、IV型股骨颈基底部骨折采用股骨近端解剖型钢板固定较中空加压螺钉疗效佳。

Objective To investigate the clinical effect of hollow compression screw and proximal femur anatomic plate in the treatment of femoral neck basal fracture in adult patients. Methods From Mar. 2008 to Jun. 2014,forty-five adult patients with femoral neck basal fracture were treated with hollow compression screw(21 cases) and proximal femur anatomic plate(24 cases),respectively. There were 19 males and 26 females aged 48.7(38-60) years. Thirty-two were on the left and 13 were on the right. According to Garden classification, 7 were type I, 15 were type Ⅱ, 13 were Ⅲ and 10 were type IV. The operation time,intraoperative blood loss,fracture healing time,postoperative complications and Harris hip score in two groups were compared and analyzed. Results All patients were followed up for an average of 32.4 months(range,20-45 months). There was no significant difference in operative time and intraoperative blood loss between the two groups(P>0.05). In the hollow compression screw fixation group,4 cases occurred fixed failure in postoperative 1-3 months,two cases healed after 3 months of traction and two cases of nonunion underwent revision procedures. In the proximal femur anatomic plate fixation group,there was 1 case of screw loosening and healing in hip varus,and 1 case of hip heterotopic ossification in postoperative 8 months. There was no statistically significant difference in postoperative complications between the two groups(P>0.05). The fracture healing time of the hollow compression screw fixation group was(16.8±1.7) weeks,significantly longer than that of the anatomical plate fixation group of(14.3±2.5) weeks,and the difference was statistically significant(P<0.01). According to Harris hip function at the final follow-up,there were 11 cases of excellent,good in 5 cases,fair in 2 cases,and poor in 3 cases,and the good and excellent rate was 76.2% in the hollow compression screw fixation group. In the proximal femur anatomic plate fixation group,there were 19 cases of excellent,good in 3 cases,and fair in 2 cases,and the good and excellent rate was 91.7%. The differences of postoperative Harris hip score in two groups were statistically significant(P<0.05). Conclusion Femoral neck basal fracture of Garden Ⅲ and IV types treated by proximal femur anatomic plate has more satisfactory clinical effectiveness than hollow compression screw.