股骨颈动力抗旋交叉钉系统或联合空心钉治疗股骨颈骨折

Femoral neck system or combined cannulated screws for femoral neck fracture

背景:股骨颈骨折可应用空心钉、动力髋螺钉、锁定钢板及髓内钉等内固定物治疗,但术后仍具有较高的内固定失败、股骨颈缩短、内翻畸形、股骨头坏死和骨不连的风险。股骨颈动力抗旋交叉钉系统能微创置入,可提供稳定的抗旋力,很少出现螺钉切割、退钉等现象。目的:对比股骨颈动力抗旋交叉钉系统与股骨颈动力抗旋交叉钉系统联合空心钉治疗股骨颈骨折的早期临床疗效。方法:回顾性分析2020年3月至2021年10月保定市第一中心医院骨科收治的42例股骨颈骨折患者的病历资料,其中33例获得随访,根据内固定方式分为2组。股骨颈动力抗旋交叉钉系统组(A组)26例,股骨颈动力抗旋交叉钉系统联合空心钉组(B组)7例。记录两组患者的手术时间、术中透视次数、术中出血量、住院时间、骨折愈合时间、末次随访时疗效(Harris评分)及并发症发生情况等。结果与结论:①33例患者术后获3-19个月随访;②A组患者的手术时间、术中透视次数及术中出血量均少于B组,差异有显著性意义(P<0.05);两组住院时间、术后及末次随访Harris评分相比差异无显著性意义(P>0.05);末次随访时A组患髋功能,优15例,良9例,可2例;B组患髋功能,优6例,良1例;③术后X射线片显示,全部患者骨折均愈合,愈合时间为3-6个月,平均4.5个月;④两组患者术后及末次随访股骨颈短缩程度比较差异无显著性意义(P>0.05);⑤随访期间两组患者均未发生感染、内固定物松动等并发症;⑥提示股骨颈动力抗旋交叉钉系统或股骨颈动力抗旋交叉钉系统联合空心螺钉固定治疗股骨颈骨折操作均较简单、微创,近期疗效满意。

BACKGROUND:Femoral neck fractures can be treated with cannulated screws,dynamic hip screws,locking plates,and intramedullary nails.However,there are still high risks of internal fixation failure,femoral neck shortening,varus deformity,femoral head necrosis and nonunion.The femoral neck system is minimally invasive and provides stable rotation resistance with minimal screw cutting and screw withdrawal.OBJECTIVE:To compare early clinical effects of femoral neck system and femoral neck system combined with cannulated screw on femoral neck fracture.METHODS:The data of 42 patients with femoral neck fracture treated in Department of Orthopedics,Baoding First Central Hospital from March 2020 to October 2021 were retrospectively analyzed.Of them,33 patients were followed up and divided into femoral neck system group(group A;n=26)and femoral neck system combined with cannulated screw group(group B;n=7).Operation time,intraoperative fluoroscopy times,intraoperative blood loss,length of hospital stay,fracture healing time,curative effect(Harris score)and complications at the last follow-up were recorded.RESULTS AND CONCLUSION:(1)Thirty-three patients were followed up for 3-19 months.(2)Operation time,intraoperative fluoroscopy times,and intraoperative blood loss were significantly less in group A than those in group B(P<0.05).Length of hospital stay and Harris score postoperatively and at final follow-up were not significantly different(P>0.05).Hip function was evaluated as follows:excellent in 15 cases,good in 9 cases,and average in 2 cases in group A;excellent in 6 cases and good in 1 case in group B.(3)Postoperative X-ray films showed that all fractures healed,and the healing time was 3-6 months,with an average of 4.5 months.(4)There was no significant difference in the degree of femoral neck shortening between the two groups after operation and at the final follow-up(P>0.05).(5)None of the patients had complications such as infection and loosening of internal fixation during follow-up.(6)The treatment of femoral neck fractures with femoral neck system or combined with cannulated screw fixation is simple and minimally invasive with satisfactory short-term results.