经皮加压钢板固定治疗股骨颈骨折的疗效研究

Effectiveness of percutaneous compression plate fixation for femoral neck fractures

目的探讨经皮加压钢板(percutaneous compression plate,PCCP)固定治疗股骨颈骨折的疗效。方法回顾分析2008年1月-2017年8月采用内固定治疗的100例股骨颈骨折患者临床资料,其中55例采用空心加压螺钉(cannulated screw,CS)内固定(CS组),45例PCCP内固定(PCCP组)。两组患者性别、年龄、致伤原因、骨折类型、合并症以及病程等一般资料比较,差异均无统计学意义(P>0.05)。比较两组骨折复位质量、断端骨吸收、螺钉滑动、股骨颈短缩以及并发症(骨不连、固定失败及股骨头坏死)发生情况,采用Harris评分评价髋关节功能。结果术后两组切口均Ⅰ期愈合。患者均获随访,随访时间24~56个月,平均30.7个月。CS组患者骨折复位质量达优26例、良18例、可9例、差2例,PCCP组达优21例、良17例、可4例、差3例,组间差异无统计学意义(Z=-0.283,P=0.773)。PCCP组骨不连发生率明显低于CS组(P=0.046),骨折愈合时间短于CS组(t=2.155,P=0.034);两组骨吸收、螺钉滑动、股骨颈短缩以及固定失败、股骨头坏死发生率比较,差异均无统计学意义(P>0.05)。CS组总体并发症发生率为27.27%(15/55),明显高于PCCP组的8.89%(4/45),差异有统计学意义(χ2=5.435,P=0.020)。术后6个月,PCCP组Harris评分明显优于CS组(t=-2.073,P=0.041);术后12、18、24个月两组差异均无统计学意义(P>0.05)。结论PCCP治疗股骨颈骨折可获得较好疗效,其稳定的滑动加压有助于骨折愈合,尤其是短缩愈合。

Objective To investigate the effectiveness of percutaneous compression plate(PCCP)fixation for femoral neck fracture.Methods A clinical data of 100 patients with femoral neck fractures who were treated with internal fixation were analyzed retrospectively.The fractures were fixed with the cannulated screws(CS)in 55 patients(CS group)and with the PCCP in 45 patients(PCCP group).There was no significant difference in gender,age,the cause of injury,the fracture type,complications,and disease duration between the two groups(P>0.05).The quality of fracture reduction,bone resorption,screw slipping,femoral neck shortening,complications(nonunion,failure of fixation,and osteonecrosis of femoral head),and functional recovery of hip(Harris score)were compared between the two groups.Results All incisions healed by first intention.All patients were followed up 24-56 months,with an average of 30.7 months.The quality of fracture reduction was excellent in 26 cases,good in 18 cases,fair in 9 cases,and poor in 2 cases in CS group and excellent in 21 cases,good in 17 cases,fair in 4 cases,and poor in 3 cases in PCCP group,showing no significant difference between the two groups(Z=-0.283,P=0.773).The incidence of nonunion in PCCP group was significantly lower than that in CS group(P=0.046),and the fracture healing time in PCCP group was shorter than that in CS group(t=2.155,P=0.034).There was no significant difference in the incidences of bone resorption,screw slipping,femoral neck shortening,failure of fixation,and osteonecrosis of femoral head between the two groups(P>0.05).The overall complication rates were 27.27%(15/55)in CS group and 8.89%(4/45)in PCCP group,showing significant difference(χ~2=5.435,P=0.020).The Harris score in PCCP group at 6 months after operation was significantly higher than that in CS group(t=-2.073,P=0.041).However,there was no significant difference in the Harris score at 12,18,and 24 months after operation between the two groups(P>0.05).Conclusion Stable sliding compression of PCCP is benefit for the femoral neck fracture healing,especially shortening union.