两种方法治疗垂直不稳定型股骨颈骨折的近期疗效对比

Comparison of the short-term effects of two methods for the treatment of vertically unstable femoral neck fractures

目的评价单纯空心螺钉与3枚空心钉加内侧支撑钢板两种方式处理股骨颈PauwelsⅢ型骨折的近期治疗效果。方法选取锦州地区55例股骨颈PauwelsⅢ型骨折患者,随机分为空心加压螺钉组30例(A组),3枚空心螺钉+支撑钢板组25例(B组)。记录术后髋关节Harris评分,对比各项手术指标、愈合时间、复位质量、股骨头坏死与骨不连等并发症的发生情况。结果A组手术时间(68.73±4.91)min,低于B组(110.76±5.85)min;A组术中出血量(69.47±5.15)mL,低于B组(110.92±10.10)mL;A组的骨折愈合时间(5.03±0.47)个月,高于B组(4.37±0.56)个月;差异均有统计学意义(P<0.05)。两组内固定失效和复位情况的对比,B组优于A组(P<0.05);在股骨头坏死和骨折不愈合方面的比较,A组高于B组(P>0.05)。术后第1、3个月的Harris分值,A组为(70.67±1.88)分、(74.83±3.69)分,低于B组(71.60±1.78)分、(76.60±3.10)分,差异无统计学意义(P>0.05);术后第6、12个月的Harris分值,A组为(78.97±1.88)分、(88.17±3.36)分,低于B组(80.08±1.93)分、(92.04±3.72)分,差异有统计学意义(P<0.05)。结论采用空心钉+支撑钢板治疗骨折线较垂直的股骨颈PauwelsⅢ型骨折的效果优于单纯3枚空心钉,拥有骨折复位质量好、更加牢靠的固定、有效抵抗垂直剪切力、缩短愈合时间,患髋功能恢复好等优点。

Objective To evaluate the short-term treatment effect of simple cannulated screws and three cannulated screws with medial support plate in the treatment of femoral neck Pauwels TypeⅢfractures.Methods Fifty-five patients with Pauwels TypeⅢfractures of the femoral neck in Jinzhou area were randomly divided into 30 cases in the cannulated compression screw group(Group A)and 25 cases in the three cannulated screw plus support plate group(Group B).Record the postoperative hip Harris score and compare the occurrence of complications such as femoral head necrosis and nonunion,and surgical index,the time of fracture healing,reduction quality.Results The operation time of Group A was(68.73±4.91)min,significantly lower than that of Group B[(110.76±5.85)min].The intraoperative blood loss in Group A was(69.47±5.15)mL,significantly lower than that of Group B[(110.92±10.10)mL].The fracture healing time in Group A was(5.03±0.47)months,significantly higher than that in Group B(4.37±0.56)months.Comparison of internal fixation failure and reduction between the two groups,Group B was significantly better than Group A(P<0.05).Compared in femoral head necrosis and fracture nonunion,Group A was higher than Group B(P>0.05).The Harris scores in the first and third months after surgery were 70.67±1.88 and 74.83±3.69 in Group A,respectively,which were lower than those in Group B(71.60±1.78 and 76.60±3.10,respectively),but there was no significant difference between them(P>0.05).Harris scores in the 6 th and 12 th month after surgery were 78.97±1.88 and 88.17±3.36 in Group A,respectively,significantly lower than Group B(80.08±1.93 and 92.04±3.72,respectively,P<0.05).Conclusion The outcomes of using hollow nail plus support plate to treat Pauwels TypeⅢfracture is better than that of three hollow nails.It has the advantages in high quality fracture reduction,stable fixation,effective against the vertical shear force,shorten the healing time,as well as good recovery of hip joint function.