倒品形空心钉治疗Pauwels Ⅲ型年轻股骨颈骨折的疗效观察

Curative effect of cannulated screws placed in inverted triangle construct in treatment of Pauwels typeⅢfemoral neck fracture in young adults

目的:探讨倒品形空心钉治疗PauwelsⅢ型年轻股骨颈骨折的临床疗效。方法:选取2014年1月~2019年12月我院收治的46例PauwelsⅢ型年轻股骨颈骨折患者,均给予倒品形空心钉治疗,观察患者手术情况及骨折复位质量、术后恢复指标和术后并发症发生情况。结果:G12组(GardenⅠ型和Ⅱ型骨折)的Garden对线指数明显优于G34组(GardenⅢ型和Ⅳ型,P=0.005),G12组骨折愈合时间为(3.60±0.91)个月,明显短于G34组骨折愈合时间(6.50±3.23)个月(P=0.001),G12组术后Harris评分为(98.20±3.47)分,明显高于G34组术后Harris评分(89.4±12.63)分(P=0.001)。术后总体并发症发生率为52.2%,其中退钉率为28.3%,切出率为4.3%,股骨颈短缩发生率为30.4%,骨折移位发生率为10.9%,骨折不愈合发生率为6.5%,股骨头坏死发生率为17.4%,G12组和G34组在各项并发症的发生率上未见明显统计学差异(P>0.05)。结论:倒品形空心钉治疗PauwelsⅢ型年轻股骨颈骨折临床疗效良好,对无移位型股骨颈骨折尤为适用,而对移位型股骨颈骨折效果较差,采用倒品形空心钉治疗PauwelsⅢ型年轻股骨颈骨折的术后总体并发症仍较高,仍有必要研究更有效的手术治疗方式。

Objective:To explore and analyze the curative effect of cannulated screws placed in inverted triangle construct in the treatment of Pauwels typeⅢfemoral neck fractures in young adults;Methods:We retrospectively analyzed 46 young adults with Pauwels typeⅢfemoral neck fractures admitted from January 2014 to December 2019 and treated by cannulated screws placed in inverted triangle construct,we summarized and compared their perioperative information,fracture reduction qualities,postoperative recovery indicators and complications;Results:G12 group(Garden typeⅠandⅡ)had better Garden alignment index than G34 group(Garden typeⅢandⅣ,P=0.005),shorter mean time to union(3.60±0.91 vs.6.50±3.23,P=0.001)and higher Harris hip score(98.20±3.47 vs.89.4±12.63,P=0.001).The included patients had a total complication rate up to 52.2%,screw withdrawal rate 28.3%,cut-out rate 4.3%,incidence of femoral neck shortening,fracture displacement,nonunion and femoral head necrosis 30.4%,10.9%,6.5%and 17.4%respectively.Besides,there was no difference in complications between G12 group and G34 group.Conclusion:Cannulated screws placed in inverted triangle construct are effective in treating Pauwels typeⅢfemoral neck fractures in young adults,especially for nondisplaced fractures.Considering the high complication rate,more studies are needed to explore a more effective treatment.