股骨颈内固定系统与单纯空心螺钉内固定治疗65岁以下股骨颈骨折的比较

Comparison of femoral neck internal fixation system and simple cannulated screw internal fixation in the treatment of femoral neck fractures in patients under 65 years old

背景:多年来,在青壮年股骨颈骨折内固定方式选择上一直存在争议,无论选择何种治疗方法,目标都是解剖复位和稳定内固定。虽然临床上治疗青壮年股骨颈骨折的内固定方式较多,但治疗效果各有优缺点,目前尚无统一的治疗方案。目的:观察新型股骨颈内固定系统治疗股骨颈骨折的疗效。方法:2019年1月至2020年6月采用股骨颈内固定系统固定21例股骨颈骨折患者(观察组)与采用3枚空心螺钉固定32例股骨颈骨折患者(对照组),年龄≤65岁。所有患者均为闭合性骨折,术前均拍患侧髋关节正位X射线片,均行CT平扫+三维重建。术后拍摄髋关节X射线片对骨折愈合及股骨头坏死情况进行判断,必要时部分病例行MRI检查。末次随访时对髋关节功能进行评估。结果与结论:(1)观察组21例患者均获得随访,平均19个月;手术时间平均58.09 min;术中透视次数平均23.19次;术中出血量平均109.29 mL;骨折临床愈合时间平均3.86个月;术后完全负重时间平均6.00个月;并发症发生率为14.3%,髋关节功能优良率85.7%;(2)对照组32例患者均获得随访,平均18个月;手术时间平均74.06 min;术中透视次数平均33.41次;术中出血量平均81.56 mL;骨折临床愈合时间平均4.69个月;术后完全负重时间平均6.72个月;并发症发生率为28.1%,髋关节功能优良率71.9%;(3)结果表明,与单纯空心螺钉内固定相比,股骨颈系统内固定可缩短65岁以下股骨颈骨折患者的手术时间及骨折临床愈合时间,减少透视次数。

BACKGROUND:For many years,the choice of internal fixation for femoral neck fractures in young adults has been controversial.No matter what treatment is chosen,the goal is the anatomical reduction and stable internal fixation.Although there are many internal fixation methods for the treatment of femoral neck fractures in young adults,the therapeutic effects have their advantages and disadvantages,and there is no unified treatment plan at present.OBJECTIVE:To observe the effect of a new type of femoral neck internal fixation system in the treatment of femoral neck fractures.METHODS:From January 2019 to June 2020,the relevant data of 21 patients with femoral neck fractures fixed by femoral neck internal fixation system(observation group)and 32 patients with femoral neck fractures fixed by three hollow nails(control group)were included in this study.The patient age was≤65 years old.All patients had closed fractures.All patients underwent anteroposterior radiography of the affected side before the operation,and all patients underwent a CT plain scan plus three-dimensional reconstruction.Fracture healing and necrosis of the femoral head were evaluated by X-ray film of the hip joint after the operation.MRI examination was performed in some cases when necessary.The hip function was assessed at the last follow-up.RESULTS AND CONCLUSION:(1)All 21 patients in the observation group were followed up for an average of 19 months.The average operation time was 58.09 minutes.The average number of fluoroscopy was 23.19 times.The average intraoperative blood loss was 109.29 mL.The average clinical healing time was 3.86 months.The mean time of complete weight bearing after the operation was 6 months.The complication rate was 14.3%.The excellent and good rate of hip joint function was 85.7%.(2)In the control group,32 patients were followed up for an average of 18 months.The average operation time was 74.06 minutes.The average number of fluoroscopy was 33.41 times.The average intraoperative blood loss was 81.56 mL.The average clinical healing time was 4.69 months.The mean time of complete weight bearing after the operation was 6.72 months.The complication rate was 28.1%.The rate of excellent and good hip function was 71.9%.(3)The results show that compared with the simple cannulated screw internal fixation,the femoral neck internal fixation system can shorten the operation time and clinical healing time of patients with femoral neck fractures under 65 years old,and reduce the frequency of fluoroscopy.