空心钉加内侧支撑钢板与单纯空心钉治疗PauwelsⅢ型股骨颈骨折的疗效比较研究

Comparative Study of Hollow Nail Plus Medial Supporting Plate and Hollow Nail in the Treatment of Pauwels TypeⅢFemoral Neck Fracture

目的:比较PauwelsⅢ型股骨颈骨折分别经单纯空心钉、空心钉加内侧支撑钢板治疗的临床疗效。方法:回顾性分析2016年3月~2019年2月期间收治的113例PauwelsⅢ型股骨颈骨折患者的临床资料,根据手术方式分为A组(n=55,单纯空心钉内固定治疗)和B组(n=58,空心钉加内侧支撑钢板治疗),比较两组患者围术期指标、髋关节功能、术后疼痛及复位质量,记录两组患者随访期间并发症发生情况。结果:B组术中出血量多于A组,手术时间长于A组(均P<0.05);B组骨折愈合时间、完全负重时间短于A组(P<0.05)。两组患者术后3个月、术后6个月髋关节Harrris评分呈升高趋势,视觉模拟评分量表(VAS)评分呈下降趋势(P<0.05);B组术后3个月、术后6个月髋关节Harrris评分高于A组,VAS评分则低于A组(P<0.05)。与术后3 d相比,A组患者术后6个月正位、侧位Garden指数降低(P<0.05);B组术后6个月正位、侧位Garden指数评分高于A组(P<0.05)。B组并发症发生率低于A组(P<0.05)。结论:与单纯空心钉内固定治疗PauwelsⅢ型股骨颈骨折相比,空心钉加内侧支撑钢板虽然术中出血量多,手术时间略长,但其术后恢复效果更佳,且并发症发生率更低,临床应用价值较高。

Objective:To compare the clinical efficacy of hollow nail plus medial supporting plate and hollow nail in the treatment of Pauwels typeⅢfemoral neck fracture.Methods:The clinical data of 113 patients with Pauwels typeⅢfemoral neck fracture who were admitted from March 2016 to February 2019 were analyzed retrospectively.According to the operation mode,the patients were divided into two groups:group A(n=55,internal fixation with hollow nail)and group B(n=58,treatment with hollow nail and internal support plate).Perioperative indexes,hip function,postoperative pain and reset quality were compared between the two groups.The complications were recorded during the follow-up period.Results:The amount of bleeding during operation in group B was more than that in group A,and the operation time was longer than that in group A(all P<0.05).The fracture healing time and full weight-bearing time in group B were shorter than those in group A(P<0.05).The Harrris score of the two groups increased at 3 months after operation and 6 months after operation,while the visual analogue scale(VAS)score decreased(P<0.05).The Harrris score of group B were higher than those of group A at 3 months and 6 months after operation,while the VAS score was lower than that of group A(P<0.05).Compared with 3 days after operation,the positive position and lateral position Garden index in group A decreased 6 months after operation(P<0.05),while the positive position and lateral position Garden index scores in group B were higher than those in group A at 6 months after operation(P<0.05).The incidence of complications in group B was lower than that in group A(P<0.05).Conclusion:Compared with the treatment of Pauwels typeⅢfemoral neck fracture with hollow nail internal fixation,hollow nail plus medial supporting plate and hollow nail has less amount of bleeding during operation,and the operation time has slightly longer.But it has better recovery effect after operation,fewer complications,and the clinical application value is higher.