动力髋螺钉+防旋螺钉与3枚空心钉固定治疗伴后侧壁碎裂的股骨颈骨折的疗效比较

Comparison of dynamic hip screw plus anti-rotation screw versus three cannulated compression screws in treatment of femoral neck fractures with comminuted posterior wall

目的比较动力髋螺钉(DHS)+防旋螺钉与3枚空心钉(CCS)固定治疗伴后侧壁碎裂的股骨颈骨折的疗效。方法回顾性分析2017年2月至2019年12月期间中国科学院大学深圳医院(光明)骨科收治的109例合并后侧壁碎裂的股骨颈骨折患者资料。根据治疗方式不同分为两组:CCS组58例,男42例,女16例;年龄为48.5(40.0,55.3)岁,采用3枚CCS固定治疗。DHS组51例,男31例,女20例;年龄为47.0(38.0,53.0)岁;采用DHS+防旋螺钉固定治疗。比较两组患者的手术切口长度、手术时间、术中出血量、患肢负重时间、疼痛视觉模拟评分(VAS)、髋关节Harris评分及并发症发生率等。结果两组患者术前一般资料及随访时间比较差异均无统计学意义(P>0.05),具有可比性。CCS组患者的手术切口长度[3.0(2.9,4.5)cm]、手术时间[90.0(73.8,125.0)min]显著短于DHS组患者[10.0(9.0,12.0)cm、135.0(110.0,165.0)min],术中出血量[40.0(10.0,100.0)mL]显著少于DHS组患者[200.0(150.0,300.0)mL],患肢部分、完全负重时间[12.0(12.0,13.0)、24.0(21.0,25.0)周]显著长于DHS组患者[11.0(10.0,12.0)、19.0(18.0,20.0)周],围手术期疼痛VAS评分[2.0(2.0,3.0)分]显著低于DHS组患者[5.0(4.0,6.0)分],但随访期间并发症发生率[56.9%(33/58)]显著高于DHS组患者[33.3%(17/51)],差异均有统计学意义(P<0.05)。DHS组与CCS组患者术后1年髋关节Harris评分优良率[94.1%(48/51)、91.4%(53/58)]比较差异均无统计学意义(P>0.05)。结论虽然DHS+防旋螺钉与3枚CCS内固定治疗伴后侧壁碎裂的股骨颈骨折的近期疗效均良好,但是后期随访并发症发生率仍较高。与后者比较,前者可缩短患肢负重时间、降低并发症发生率,但创伤较大。

Objective To compare the efficacy of 2 fixation modes[dynamic hip screw(DHS)plus anti-rotation screw versus 3 cannulated compression screws(CCS)]in the treatment of femoral neck fractures complicated with comminuted posterior wall.Methods The data were analyzed retrospectively of the 109 patients who had been treated for femoral neck fractures complicated with comminuted posterior wall at Department of Orthopaedics,Shenzhen Hospital,University of Chinese Academy of Sciences from February 2017 to December 2019.They were divided into 2 groups according to 2 fixation modes.There were 42 males and 16 females with an age of 48.5(40.0,55.3)years in CCS group of 58 cases subjected to fixation with 3 CCSs;there were 31 males and 20 females with an age of 47.0(38.0,53.0)years in DHS group of 51 cases subjected to fixation with DHS plus anti-rotation screw.The length of incision,operation time,intraoperative bleeding,weight-bearing time for the affected limb,visual analog scale(VAS),hip Harris score,and incidence of postoperative complications were compared between the 2 groups.Results The comparison of preoperative general data between the 2 groups was not statistically significant,showing comparability between groups(P>0.05).In the CCS group,the incision length[3.0(2.9,4.5)cm]and operation time[90.0(73.8,125.0)min]were significantly shorter than those in the DHS group[10.0(9.0,12.0)cm and 135.0(110.0,165.0)min],the intraoperative bleeding[40.0(10.0,100.0)mL]was significantly less than that in the DHS group[200.0(150.0,300.0)mL],the partial and complete weight-bearing durations of the affected limb[12.0(12.0,13.0)weeks and 24.0(21.0,25.0)weeks]were significantly longer than those in the DHS group[11.0(10.0,12.0)weeks and 19.0(18.0,20.0)weeks],and the perioperative VAS pain score[2.0(2.0,3.0)points]was significantly lower than that in the DHS group[5.0(4.0,6.0)points],but the incidence of follow-up complications[56.9%(33/58)]was significantly higher than that in the DHS group[33.3%(17/51)](all P<0.05).There was no significant difference between the DHS group and the CCS group in the excellent and good rate of Harris hip score at one year after operation[94.1%(48/51)versus 91.4%(53/58)](P>0.05).Conclusions In the treatment of femoral neck fractures complicated with comminuted posterior wall,DHS plus anti-rotation screw and 3 CCSs can both result in fine therapeutic outcomes but a relatively high incidence of complications at late follow-up.However,the former fixation mode can shorten the weight-bearing time for the affected limb and reduce complications but is more invasive than the latter fixation mode.