空心钉联合内侧支撑钢板术治疗中青年PauwelsⅢ型股骨颈骨折的疗效

Effect of hollow screw combined with medial support plate in the treatment of young and middle-aged Pauwels type Ⅲ femoral neck fractures

目的观察空心钉联合内侧支撑钢板术治疗中青年PauwelsⅢ型股骨颈骨折的临床疗效。方法回顾性分析2016年12月—2018年3月河南省洛阳正骨医院髋部损伤科收治PauwelsⅢ型股骨颈骨折中青年患者74例,按手术方式不同分为对照组和观察组,各37例。观察组行空心螺钉联合内侧支撑钢板术治疗,男性17例,女性20例;年龄18~44岁,平均30.9岁;高处坠落伤20例,道路交通伤13例,摔伤4例。对照组行空心螺钉内固定术治疗,男性16例,女性21例;年龄18~45岁,平均30.9岁;高处坠落伤21例,道路交通伤12例,摔伤4例。比较两组患者术中出血量、手术时间、住院时间、术后开始负重时间、骨折愈合时间、视觉模拟评分(VAS)、髋关节功能评分(Harris评分)、术后骨折复位质量及术后并发症发生率。结果观察组术中出血量(176.39±24.72)mL多于对照组(138.56±22.65)mL,P<0.05;且观察组手术时间(75.65±6.51)min、术后开始负重时间(17.28±2.65)d均长于对照组(63.25±6.42)min、(15.35±2.34)d,差异均有统计学意义(P<0.05);观察组骨折愈合时间(4.25±1.38)个月短于对照组(5.65±1.53)个月,P<0.05,两组患者住院时间比较差异无统计学意义。两组患者术后3、6个月VAS均降低,Harris评分均升高(P<0.05),且观察组术后3、6个月VAS[(3.64±0.58)分、(0.95±0.32)分]低于对照组[(4.76±0.62)分、(1.91±0.38)分],P<0.05;观察组术后3、6个月Harris评分[(73.59±7.25)分、(94.45±7.36)分]高于对照组[(58.36±6.85)分、(73.46±7.15)分],P<0.05。观察组术后骨折复位质量优于对照组(97.29%vs.81.08%,χ^(2)=5.045,P=0.025)。随访24个月,观察组术后骨折不愈合、股骨头缺血性坏死、内固定失败等发症发生率低于对照组(5.40%vs.21.62%)(χ^(2)=4.163,P=0.041)。结论空心钉联合内侧支撑钢板术治疗PauwelsⅢ型股骨颈骨折患者效果显著,骨折复位质量满意,有效改善患者疼痛,减少术后并发症的发生,促进髋关节功能恢复。

Objective To observe the clinical effect of hollow screw combined with medial support plate in the treatment of young and middle-aged Pauwels type Ⅲ femoral neck fractures.Methods A retrospective analysis was conducted in 74 young and middle-aged patients with Pauwels type Ⅲ femoral neck fractures admitted to the Department of Hip Injury,Luoyang Orthopedic Hospital of Henan Province from Dec.2016 to Mar.2018,who were divided into control group and observation group according to different surgical methods,with 37 cases in each group.The observation group was treated with hollow screw combined with medial support plate.There were 17 males and 20 females,with an average of 30.9 years(range,18-44 years);the causes of injury:20 cases of falling injuries from heights,13 cases of road traffic injuries,and 4 cases of falling injuries.The control group was treated with hollow screw internal fixation alone.There were 16 males and 21 females,with an average of 30.9 years(range,18 to 45 years).Causes of injury:21 cases of falling injuries from heights,12 cases of road traffic injuries,and 4 cases of fall injuries.The intraoperative blood loss,operation time,hospital stay,postoperative weight-bearing time,fracture healing time,visual analog scale(VAS),hip function score(Harris score),postoperative fracture reduction quality and postoperative complications were compared between the two groups.Results The intraoperative blood loss in the observation group was(176.39±24.72)mL,which was more than(138.56±22.65)mL in the control group,P<0.05;the operation time of the observation group was(75.65±6.51)minutes,and the postoperative weight-bearing time was(63.25±6.42)days,which were longer than those in the control group[(63.25±6.42)minutes and(15.35±2.34)days,P<0.05];the fracture healing time of the observation group was(4.25±1.38)months,shorter than that of the control group of(5.65±1.53)months,P<0.05.The VAS of the two groups of patients decreased at 3 and 6 months after surgery,and the Harris score increased(P<0.05),and the VAS of the observation group was(3.64±0.58)points and(0.95±0.32)points at 3 and 6 months after surgery,which were lower than those of the control group[(4.76±0.62)points,(1.91±0.38)points,P<0.05];the Harris score of the observation group was(73.59±7.25)points and(94.45±7.36)points at 3 and 6 months after surgery,higher than that of the control group[(58.36±6.85)points,(73.46±7.15)points,P<0.05].The quality of postoperative fracture reduction in the observation group was significantly better than that of the control group(97.29%vs.81.08%,χ^(2)=5.045,P=0.025).The 24-months follow-up showed that the incidence of postoperative complications such as nonunion of fracture,avascular necrosis of the femoral head,and internal fixation failure in the observation group was lower than that in the control group(5.40%vs.21.62%,χ^(2)=4.163,P=0.041).Conclusion Hollow screw combined with medial support plate surgery can obtain a satisfactory effect in the treatment of patients with Pauwels Ⅲ femoral neck fracture.The quality of fracture reduction is satisfactory,which can effectively improve the pain of patients,reduce the occurrence of postoperative complications,and promote the recovery of hip joint function.