经皮闭合复位四枚空心钉固定治疗PauwelsⅢ型股骨颈骨折的临床疗效

Research on Clinical Efficacy of Percutaneous Fixation Reduction with Four Cannulated Screws in the Treatment of Pauwels TypeⅢFemoral Neck Fracture

目的通过对比研究,探讨经皮闭合复位四枚空心钉固定治疗PauwelsⅢ型股骨颈骨折的临床疗效。方法选取在2015年2月至2017年2月期间,根据Pauwels原始分类将所有高能量垂直股骨颈骨折归为Ⅲ型的成年患者32名,随机分配两组,对照组采用闭合复位传统三枚空心钉固定,实验组采用闭合复位四枚空心钉固定,对比采用不同数量空心钉固定的两组患者在临床治疗效果、愈合时间、Harris评分、闭合复位质量的差异。结果两组临床疗效,实验组显著高于对照组(χ^(2)=4.800,P=0.028<0.05),具有统计学意义;治疗前实验组Harris评分为(67.69±2.27)分,低于对照组的(68.13±2.50)分,但是差异没有统计学意义(P>0.05);治疗后实验组Harris评分为(92.06±1.98)分,显著高于对照组的(90.20±2.40)分(P=0.02),差异有统计学意义。术后的闭合复位质量比较,实验组复位质量I级显著高于对照组(χ^(2)=5.236,P=0.022<0.05),实验组评级为Ⅰ-Ⅱ级占比81.3%,高于对照组的43.8%,差异有统计学意义(P<0.05)。结论PauwelsⅢ型股骨颈骨折患者采用闭合复位经皮4枚空心钉内固定治疗的方式,具有较好的临床治疗疗效,同时在改善患者术后髋关节功能评分上具有一定的优势。

Objective According to comparative study,the clinical efficacy of percutaneous fixation reduction with four cannulated screws in the treatment of Pauwels typeⅢfemoral neck fracture was discussed.Method 32 adult patients with high-energy vertical femoral neck fractures classified as typeⅢbased on the original Pauwels classification were randomly assigned to two groups from February 2015 to February 2017.The control group was treated with closed reduction and traditional three cannulated screws fixation,and the experimental group was treated with closed reduction and four hollow screws fixation.The clinical therapeutic effect,healing time,Harris score and quality of closed reduction were compared between the two groups.Result For the clinical efficacy,the experimental group was significantly higher than that of the control group(χ^(2)=4.800,P=0.028<0.05),which had statistical significance.Before treatment,the Harris score of the experimental group was(67.69±2.27),which was lower than that of the control group(68.13±2.50),but the difference was not statistically significant(P>0.05).After treatment,the Harris score of the experimental group was(92.06±1.98),which was significantly higher than that of the control group(90.20±2.40)(P=0.02).The difference was statistically significant.In terms of the quality of closed reduction,the experimental group was significantly higher than that in the control group(χ^(2)=5.236,P=0.022<0.05),and 81.3%of the experimental group was graded as gradeⅠ-Ⅱ,which was higher than 43.8%of the control group(P<0.05).The difference was statistically significant(P<0.05).Conclusion The patients with Pauwels typeⅢfemoral neck fracture who adopted the treating way of closed reduction and percutaneous internal fixation with 4 cannulated screws obtained good clinical curative effect.At the same time,it has certain advantages in improving postoperative hip function score of the patients.