加压支撑螺钉与单头螺纹空心钉内固定治疗中青年PauwelsⅢ型股骨颈骨折疗效比较

A comparative study of internal fixation between double compression buttress screws and single-threaded cannulated screws for Pauwels type Ⅲ femoral neck fractures in young and middle-aged adults

目的比较双头加压半螺纹空心钉联合全螺纹空心钉加压支撑固定与传统倒三角形分布单头螺纹空心钉内固定治疗中青年PauwelsⅢ型股骨颈骨折的临床疗效。方法回顾性分析自2014-01—2018-06采用闭合复位3枚空心钉内固定治疗的86例中青年PauwelsⅢ型股骨颈骨折,其中41例采用双头加压半螺纹空心钉联合全螺纹空心钉加压支撑固定(加压支撑组),45例采用传统倒三角形分布单头螺纹空心钉内固定(单头螺钉组)。比较两组骨折愈合时间、股骨颈短缩畸形程度、并发症发生率,以及末次随访时髋关节功能Harris评分、髋关节屈伸活动度。结果86例术后均获得随访,随访时间平均22(15~36)个月。加压支撑组与单头螺钉组骨折愈合时间差异无统计学意义(P>0.05)。加压支撑组垂直方向、水平方向上股骨颈短缩程度小于单头螺钉组,髋关节屈伸活动度大于单头螺钉组,髋关节功能Harris评分高于单头螺钉组,螺钉退出发生率低于单头螺钉组,差异有统计学意义(P<0.05)。结论双头加压支撑螺钉内固定治疗中青年PauwelsⅢ型股骨颈骨折疗效可靠,与单头拉力螺钉内固定比较显著减小了术后股骨颈短缩程度,降低了退钉发生率,患者可获得更佳的髋关节功能,并不会延长骨折愈合时间,也不会增加术后骨折不愈合、股骨头坏死发生率。

ObjectiveTo compare the clinical efficacy of double compression semi-threaded cannulated screws combined with full-threaded cannulated screw compression support fixation with traditional inverted triangular distribution single-threaded cannulated screw internal fixation in the treatment of Pauwels typeⅢfemoral neck fractures in young and middle-aged adults.MethodsA retrospective analysis was conducted of the 86 young and middle-aged patients with Pauwels typeⅢfemoral neck fractures,treated with closed reduction internal fixation by 3 cannulated screws from January 2014 to June 2018,of which 41 were fixed with double-headed compression semi-threaded cannulated screws combined with fully-threaded cannulated screws with compression support(compression-supported group)and 45 were fixed with traditional inverted triangular distribution single-threaded cannulated screws(single-threaded screw group).The fracture healing time,shortening and deformity of femoral neck,postoperative complications,Harris hip function score and hip flexion and extension mobility at the last followup were compared between the two groups.Results Eighty-six cases were all followed-up after surgery,with a mean of 22(15-36)months.There was no statistically significant difference in fracture healing time between the compression-supported group and the single-threaded screw group(P>0.05).The shortening of femoral neck in the vertical and horizontal directions in the compression-supported group was less than that in the single-threaded screw group,and the hip flexion and extension mobility in the compression-supported group was greater than that in the single-threaded screw group,and the Harris hip function score in the compression-supported group was higher than that in the single-threaded screw group,and the incidence of screws withdrawal in the compression-supported group was lower than that in the single-threaded screw group,with statistically significant differences(P<0.05).Conclusion The double-threaded compression buttress screw internal fixation for treatment of Pauwels typeⅢfemoral neck fractures in young and middle-aged adults is effective,and significantly reduces postoperative shortening of femoral neck and the incidence of screws withdrawal compared with internal fixation of inverted triangular singlethreaded lag screws,resulting in better hip function without prolonging fracture healing time or increasing the incidence of postoperative fracture nonunion and osteonecrosis of the femoral head.