4枚不平行空心螺钉与3枚平行空心螺钉治疗股骨颈骨折的疗效对比

Comparison of Four Non-parallel Cannulated Screws and Three Parallel Cannulated Screws in the Treatment of Femoral Neck Fracture

目的比较4枚空心螺钉(four cannulated screws,FCS)与3枚空心螺钉(three cannulated screws,TCS)治疗股骨颈骨折的疗效。方法回顾性分析我科2018年1月~2020年4月117例股骨颈骨折的临床资料,根据手术方法分为TCS组(n=64)和FCS组(n=53),按照Garden分型进行亚组分析,比较2组手术时间、术中出血量、住院时间、股骨颈短缩长度(length of femoral neck shortening,LFNS)、大腿软组织刺激症状(soft tissue irritation of the thigh,STIT)、术后24个月Harris髋关节评分和内固定失败情况。结果所有患者术后随访24~32个月,中位随访时间24个月。非移位型骨折2个亚组手术时间、术中出血量、住院时间、内固定失败率(internal fixation failure rate,IFFR)、STIT发生率和术后24个月Harris髋关节评分均无统计学差异(P>0.05),FCS组LFNS更小[1.9(0.3,3.5)mm vs.2.5(1.6,3.5)mm,Z=-2.112,P=0.035]。移位型骨折2个亚组手术时间、术中出血量、住院时间和IFFR均无统计学差异(P>0.05),FCS组术后1年LFNS更小[1.2(0.3,4.0)mm vs.5.7(2.1,9.3)mm,Z=-3.077,P=0.002],STIT发生率更低[12.0%(3/25)vs.50.0%(8/16),χ^(2)=5.371,P=0.020],术后24个月Harris髋关节评分中位数明显高于TCS组[91.0(86.5,94.5)分vs.89.0(74.0,91.8)分,Z=-2.064,P=0.040]。2组均未发生股骨头坏死等并发症。结论FCS与TCS治疗股骨颈骨折IFFR无明显差异,但FCS可以有效减小术后LFNS,使移位型骨折患者获得更佳的髋关节功能。

Objective To compare clinical efficacy of four cannulated screws(FCS)and three cannulated screws(TCS)in the treatment of femoral neck fracture.Methods A retrospective study was conducted to analyze the clinical data of 117 patients with femoral neck fracture admitted to our department from January 2018 to April 2020.According to surgical methods,the patients were divided into TCS group(n=64)and FCS group(n=53).The subgroup analysis was conducted according to the Garden classification.The operation time,blood loss,hospitalization time,length of femoral neck shortening(LFNS),soft tissue irritation of the thigh(STIT),Harris hip score,and internal fixation failure rate(IFFR)were compared between the two groups.Results All the patients were followed up for 24-32 months,with a median of 24 months.For undisplaced fractures,the subgroup analysis had no significant differences in the operation time,blood loss,hospitalization time,IFFR,STIT,or Harris hip score(P>0.05).The 1-year LFNS was lower in the FCS group with statistically significant difference[1.9(0.3,3.5)mm vs.2.5(1.6,3.5)mm,Z=-2.112,P=0.035].For displaced fractures,the subgroup analysis showed no significant differences in the operation time,blood loss,hospitalization time,and IFFR(P>0.05).The LFNS was lower in the FCS group with statistically significant difference[1.2(0.3,4.0)vs.5.7(2.1,9.3)mm,Z=-3.077,P=0.002].The STIT rate was lower in the FCS group with statistically significant difference[12.0%(3/25)vs.50.0%(8/16),χ^(2)=5.371,P=0.020].The Harris hip score was significantly higher in the FCS group[91.0(86.5,94.5)points vs.89.0(74.0,91.8)points,Z=-2.064,P=0.040].There were no complications such as femoral head necrosis in both groups.Conclusion There is no significant difference between FCS and TCS in terms of IFFR in the treatment of femoral neck fracture,but FCS can effectively reduce the degree of postoperative LFNS and enable patients to obtain better hip function.