正三角构型、倒三角构型空心螺钉内固定及股骨颈动力交叉钉系统固定治疗股骨颈骨折的有效性分析

Analysis of positive and inverted triangle cannulated compression screws and femoral neck dynamic cross nail fixation system in the treatment of femoral neck fracture

目的比较正三角构型(PCCS)和倒三角构型(ICSS)空心螺钉内固定及股骨颈动力交叉钉系统(FNS)固定治疗股骨颈骨折的有效性。方法回顾性分析2018年5月—2020年5月保定市第一中心医院骨科收治的204例股骨颈骨折患者资料,按照内固定方式不同分为正三角构型空心螺钉内固定组(PCSS组,n=64)、倒三角构型空心螺钉内固定组(ICSS组,n=68)和股骨颈动力交叉钉组(FNS组,n=72)。PCSS组:男性34例,女性30例;年龄25~63岁,平均42.2岁;致伤原因:跌倒伤23例,高处坠落伤22例,道路交通伤19例。ICSS组:男性36例,女性32例;年龄20~63岁,平均41.7岁;致伤原因:跌倒伤24例,高处坠落伤22例,道路交通伤22例。FNS组:男性37例,女性35例;年龄23~64岁,平均42.3岁;致伤原因:跌倒伤26例,高处坠落伤24例,道路交通伤22例。比较三组患者手术出血量、手术时间、住院时间、骨折愈合时间、透视次数、术后髋关节Harris评分、术后并发症情况。结果三组的手术出血量、住院时间差异无统计学意义(P>0.05);FNS组的手术时间、骨折愈合时间、透视次数均少于PCSS组和ICSS组,髋关节Harris评分高于PCSS组和ICSS组(P<0.05)。FNS组的术后并发症发生率(11%)低于PCSS组(31%)和ICSS组(30%),差异有统计学意义(P<0.05)。等级资料的秩和检验结果显示,FNS组的股骨颈短缩比例优于PCSS组和ICSS组,PCSS组和ICSS组比较则差异无统计学意义(P>0.05)。结论与PCCS、ICCS固定相比,FNS固定治疗股骨颈骨折能够有效缩短手术时间和骨折愈合时间,减少术中透视次数,促进髋关节功能恢复,减少术后并发症,减轻术后股骨颈短缩情况。

Objective To compare the effectiveness of positive triangle cannulated compression screws(PCCS),inverted triangle cannulated compression screws(ICSS)and femoral neck system(FNS)fixation in the treatment of femoral neck fractures.Methods The clinical data of 204 patients with femoral neck fractures admitted to Department of Orthopaedics of Baoding First Central Hospital from May 2018 to May 2020 were retrospectively collected,and they were divided into PCSS group(n=64),ICSS group(n=68)and FNS group(n=72)according to the methods of fixation.PCSS group:34 males and 30 females;aged 25-63 years,with an average age of 42.2 years;23 cases of fall injury,22 cases of falling from height,and 19 cases of road traffic injury.ICSS group:36 males and 32 females;aged 20-63 years,with an average age of 41.7 years;24 cases of fall injury,22 cases of falling from heights,and 22 cases of road traffic injuries.FNS group:37 males and 35 females;aged from 23 to 64 years,with an average age of 42.3 years;26 cases of fall injury,24 cases of falling from heights,and 22 cases of road traffic injuries.The operation blood loss,operation time,hospital stay,fracture healing time,number of fluoroscopy,postoperative Harris score of hip joint and postoperative complications were compared among the three groups.Results There was no significant difference in the amount of operative blood loss and hospital stay among the three groups(P>0.05).The operative time,fracture healing time and the number of fluoroscopy in the FNS group were less than those in the PCSS and ICSS groups,and the Harris hip score was higher than those in PCSS and ICSS groups(P<0.05).The incidence of postoperative complications in the FNS group(11%)was lower than that in the PCSS group(31%)and the ICSS group(30%),and the difference was statistically significant(P<0.05).The results of rank sum test of grade data showed that the shortening ratio of femoral neck in FNS group was better than that in PCSS group and ICSS group(P<0.05),and there was no significant difference between PCSS group and ICSS group(P>0.05).Conclusion Compared with the positive triangle configuration and the inverted triangle configuration fixation,the fixation of the femoral neck dynamic crossover system has obvious advantages in treating the femoral neck fracture,which can effectively shorten the surgical time and the fracture healing time,reduce the number of intraoperative fluoroscopy,promote the recovery of the hip function,reduce the postoperative complications,and reduce the shortening of the postoperative femoral neck.