加压支撑螺钉与部分螺纹空心螺钉固定青壮年股骨颈骨折术后并发症的前瞻性队列研究

Postoperative complications in young adults with femoral neck fracture after internal fixation with compression buttress screws versus partially threaded cannulated screws:a prospective cohort study

目的比较加压支撑螺钉(CBS)与传统3枚平行部分螺纹空心螺钉(PTS)固定治疗青壮年股骨颈骨折的术后并发症发生率。方法选取2016年7月至2017年12月期间上海交通大学附属第六人民医院骨科就诊的120例青壮年股骨颈骨折患者进行前瞻性队列研究。根据患者自身意愿,60例接受PTS固定(对照组),男38例,女22例;年龄为(46.1±7.6)岁;改良Pauwels分型:Ⅰ、Ⅱ型17例,Ⅲ型43例。60例接受CBS固定(观察组),男42例,女18例;年龄为(44.8±8.1)岁,改良Pauwels分型:Ⅰ、Ⅱ型11例,Ⅲ型49例。比较两组患者的术后并发症发生率。同时依据Pauwels分型进行分层分析。结果两组患者术前一般资料的比较差异均无统计学意义(P>0.05),具有可比性。观察组患者的内固定失效(8.3%,5/60)、骨不连(5.0%,3/60)、<10 mm股骨颈短缩(10.0%,6/60)及向外侧退钉的发生率(11.7%,7/60)均显著低于对照组患者[38.3%(23/60)、28.3%(17/60)、41.7%(25/60)、71.7%(43/60)],差异有统计学意义(P<0.05)。而两组患者的股骨头缺血性坏死和向内侧移位的发生率比较差异均无统计学意义(P>0.05)。在改良PauwelsⅢ型骨折中,观察组患者内固定失效和骨不连发生率较对照组患者更低,差异均有统计学意义(P<0.05)。无论是改良PauwelsⅢ型骨折还是Ⅰ、Ⅱ型骨折,对照组患者<10 mm股骨颈短缩和内固定物松动的发生率均高于观察组患者,差异有统计学意义(P<0.05)。结论与PTS固定相比,CBS固定显著降低了青壮年股骨颈骨折患者的术后并发症发生率,尤其是在高能量改良PauwelsⅢ型股骨颈骨折类型中。

Objective To compare the complications in young adults with femoral neck fracture after internal fixation with compression buttress screws(CBS)versus 3 parallel partially threaded cannulated screws(PTS).Methods A prospective study was conducted of the 120 young adults with femoral neck fracture who had been treated from July 2016 to December 2017 at Department of Orthopaedic Surgery,Shanghai Sixth People's Hospital.Of them,60 were subjected to PTS fixation(control group)and 60 to CBS fixation(observation group)according to their will.In the control group,there were 38 males and 22 females with an age of(46.1±7.6)years,and 17 cases of typesⅠ-Ⅱ and 43 cases of type Ⅲ by the modified Pauwels classification;in the observation group,there were 42 males and 18 females with an age of(44.8±8.1)years,and 11 cases of typesⅠ-Ⅱand 49 cases of typeⅢ.The 2 groups were compared in postoperative complications.A stratified analysis was performed according to the modified Pauwels classification.Results Comparability was indicated between the 2 groups because there was no significant difference in their baseline demographic information(P>0.05).The incidences of fixation failure(8.3%,5/60),nonunion(5.0%,3/60),femoral neck shortening<10 mm(10.0%,6/60)and lateral withdrawal(11.7%,7/60)in the observation group were significantly lower than those in the control group[38.3%(23/60),28.3%(17/60),41.7%(25/60)and 71.7%(43/60),respectively](P<0.05).There was no significant difference in the incidence of avascular necrosis of the femoral head or of medial migration between the 2 groups(P>0.05).The stratified analysis showed that the incidences of fixation failure and nonunion in the observation group were significantly lower than in the control group for fractures of the modified Pauwels type Ⅲ(P<0.05).The incidences of femoral neck shortening<10 mm and fixation loosening in the control group were significantly higher than in the observation group for fractures of all the modified Pauwels types(P<0.05).Conclusion Compared with conventional PTS fixation,CBS fixation can significantly reduce postoperative complications in young adults with femoral neck fracture,especially those with high energy fracture of the modified Pauwels type Ⅲ.