股骨颈系统与空心钉固定青壮年股骨颈骨折

Femoral neck system versus cannulated screws for femoral neck fractures in young and middle-aged

[目的]比较股骨颈系统(femoral neck system,FNS)与空心钉(cannulated screws,CS)治疗青壮年股骨颈骨折的临床疗效。[方法]回顾性分析2019年6月—2021年1月本院诊治的137例青壮年股骨颈骨折患者的临床资料,依据医患沟通结果,64例采用FNS固定(FNS组),73例采用CS固定(CS组)。比较两组围手术期、随访和影像资料。[结果]FNS组手术时间、透视次数、部分负重时间均优于CS组(P<0.05)。FNS组在术后3、7、30 d的VAS评分显著优于CS组(P<0.05)。两组患者术后均获12个月以上随访,FNS组1例(1.56%),CS组2例(2.7%)改行THA。随术后时间推移,两组Harris评分、髋屈-伸及内-外旋ROM均显著增加(P<0.05)。术后相应时间点,FNS组的Harris评分、髋屈-伸及内-外旋ROM均显著优于CS组(P<0.05)。影像方面,FNS组影像骨折愈合时间显著早于CS组(P<0.05),术后即刻两组间Garden对线指数、股骨颈短缩、颈干角的差异无统计学意义(P>0.05),末次随访时,FNS组股骨颈短缩发生率、颈干角及内固定切出率均显著优于CS组(P<0.05)。[结论]与CS相比,FNS固定牢靠,利于术后髋关节功能的恢复和骨折愈合,临床疗效更优。

[Objective]To compare the clinical outcomes of femoral neck system(FNS)versus cannulated screw(CS)for femoral neck fractures in young and middle-aged.[Methods]A retrospective study was conducted on 137 young and middle-aged patients who had been surgically treated for femoral neck fracture at our hospital from June 2019 to January 2021.Based on preoperative doctor-patient communication,64 patients had the fractures fixed with FNS,while the remaining 73 patients were with CS.The perioperative,follow-up and imaging data were compared between the two groups.[Results]All patients in both groups had operation performed smoothly without serious complication.The FNS group proved significantly superior to the CS group in terms of operation time,fluoroscopy frequency,postoperative partial weight-bearing time,as well as VAS scores at 3,7,and 30 days postoperatively(P<0.05).All the patients in both groups were followed up for more than 12 months,and the revision surgery of total hip arthroplasty was performed in 1 case only(1.56%)in the FNS group,whereas 2 cases(2.7%)in the CS group.The Harris score,flexion-extension and internal-external rotation range of motions of the hip(ROMs)increased significantly in both groups over time postoperatively(P<0.05),which in the FNS group proved significantly superior to those in the CS group at all corresponding time points(P<0.05).With respect to radiographic evaluation,although there were no significant differences in term of Garden index,neck shortening and neck-shaft angle between the two groups immediately postoperatively(P>0.05),the FNS group proved significantly superior to the CS group in terms of radiographic fracture healing time,as well as femoral neck shortening,neck-shaft angle and internal fixation loosening at the latest follow up(P<0.05).[Conclusion]The FNS has an advantage of firm fixation of the fracture,which facilitates fracture healing and functional recovery for femoral neck fractures in young and middle-aged over the CS.