空心拉力螺钉“F”形固定Pauwels Ⅲ型股骨颈骨折

F-shaped cannulated lag screws placement for internal fixation of Pauwels type Ⅲ femoral neck fracture

[目的]评估空心拉力螺钉F形固定治疗PauwelsⅢ型股骨颈骨折的效果。[方法] 2017年5月—2019年3月本院采用3枚空心拉力螺钉闭合复位内固定治疗PauwelsⅢ型股骨颈骨折患者96例。其中,50例采用F形置钉固定,46例采用平行置钉固定。比较两组围手术期情况、随访期及影像效果。[结果]两组均顺利完成手术,无严重并发症。两组手术时间、切口长度、术中出血量差异均无统计学意义(P>0.05)。但F形组住院时间显著少于平行组(P<0.05)。所有患者随访12~32个月,平均(15.52±3.41)个月。随术后时间推移,两组患者VAS评分显著减小,而Harris评分和髋ROM显著增加(P<0.05)。末次随访时,F形组VAS评分、髋屈-伸ROM和Harris评分均显著优于平行组(P<0.05)。影像学方面,F形组骨折复位Garden对线指数和影像骨折愈合时间均显著优于平行组(P<0.05)。[结论]对PauwelsⅢ型股骨颈骨折,F形空心钉置钉可改进骨折复位质量,增加固定稳定性,有利功能恢复。

[Objective] To evaluate the clinical outcomes of F-shaped cannulated lag screws placement for internal fixation of Pauwels type Ⅲ femoral neck fracture. [Methods] A total of 96 patients received closed reduction and internal fixation with 3 cannulated lag screws for Pauwels type Ⅲ femoral neck fracture in our hospital from May 2017 to March 2019. Among them, 50 patients had the screws placed in “F” shape, while the other 46 patients had the lag screws inserted parallelly. The documents regarding to perioperative period, follow-up period and radiographs were compared between the two groups. [Results] All patients in both groups were successfully operated on without serious complications. There were no significant differences in operative time, incision length, intraoperative blood loss and length of hospital stay between the two groups(P>0.05). All the patients were followed up for 12~32 months, with an average of(15.52±3.41) months. The VAS score decreased significantly, whereas hip extension-flexion range of motion(ROM) and Harris score increased significantly over time postoperatively in both groups(P<0.05), which in the F-shaped group was significantly superior to the parallel group at the latest follow up(P<0.05). Radiographically, the F-shaped group proved significantly superior to the parallel group in term of fracture reduction quality measured by Garden alignment index and fracture healing time revealed radiographically(P<0.05). [Conclusion] The F-shaped placement of cannulated lag screws for internal fixation of Pauwels type Ⅲ femoral neck fracture does improve the quality of fracture reduction, increase the stability of fixation, and is benefit for functional recovery.