在高海拔地区应用股骨颈交叉系统内固定治疗股骨颈骨折

Femoral neck system for internal fixation of femoral neck fracture in high altitude areas

背景:治疗股骨颈骨折一直是临床的研究热点,股骨颈交叉系统微创固定是真正意义上的微创,但存在长期随访的不足。目的:探讨高海拔地区使用股骨颈动力交叉钉系统治疗股骨颈骨折的近期疗效。方法:选取青海省人民医院创伤骨科2019年11月至2021年1月收治的24例股骨颈骨折患者,根据使用内固定材料不同分为2组,股骨颈交叉系统组14例使用股骨颈交叉系统固定;中空螺钉组10例使用传统中空螺钉固定,术后均进行对症治疗,并指导患者进行相应的下肢功能康复训练。结果与结论:①术后随访6-20个月,所有患者均未出现切口问题或骨折端不愈合、内固定失败等并发症;②两组患者都获得满意的复位质量;两组患者手术时间比较差异无显著性意义(P>0.05);术中透视次数股骨颈交叉系统组少于中空螺钉组(P<0.05);两组患者骨折愈合时间相比差异无显著性意义(P>0.05);③两组患者均未发生股骨头坏死;直到末次随访时,复查X射线片示两组均未发生股骨颈的短缩愈合;④两组患者术后末次随访髋关节功能Harris评分相比差异无显著性意义(P>0.05);⑤提示在高海拔地区使用股骨颈交叉钉系统治疗股骨颈骨折创伤小,与传统中空螺钉内固定相比可明显减少术中透视次数,获得比较满意的近期疗效,符合创伤快速康复的原则理念。

BACKGROUND:Treatment of femoral neck fracture has always been a clinical research hotspot.Minimally invasive fixation using the femoral neck system is minimally invasive in the true sense,but there is a lack of long-term follow-ups.OBJECTIVE:To investigate the short-term effectiveness of femoral neck system in the treatment of femoral neck fracture in high altitude areas.METHODS:Twenty-four patients with femoral neck fracture admitted to the Department of Trauma Orthopedics of Qinghai Provincial People’s Hospital from November 2019 to January 2021 were divided into two groups according to different internal fixation materials:a femoral neck system group(n=14)and a hollow screw group(n=10).Patients in the femoral neck system group were treated with femoral neck system internal fixation,while patients in the hollow screw group were treated with traditional hollow screw internal fixation.Symptomatic treatment was performed in all patients after operation,and the corresponding lower limb functional rehabilitation training was conducted under the guidance.RESULTS AND CONCLUSION:All patients were followed up for 6-20 months,and none of them developed incision infection,nonunion of fracture ends,and internal fixation failure.Patients in both groups were all satisfied with the reduction of fracture.There was no significant difference in operation time and fracture healing time between the two groups(P>0.05).Intraoperative fluoroscopy frequency in the femoral neck system group was significantly lower than that in the hollow screw group(P<0.05).There was no necrosis of femoral head in the two groups.During the last follow-up,the radiological examination showed no appearance of femoral neck shortening in both groups,and there was also no significant difference in Harris score of hip function between the two groups(P>0.05).To conclude,compared with the traditional hollow screw internal fixation,the femoral neck system is characterized by less trauma and lower intraoperative fluoroscopy frequency in the treatment of femoral neck fracture in high altitude area.The femoral neck system can obtain satisfactory short-term effectiveness,which is in line with the principle of rapid trauma recovery.