两种股骨颈固定方案治疗股骨颈骨折的临床疗效比较

Comparison on clinical efficacy of two femoral neck fixation regimens in the treatment of femoral neck fractures

目的观察闭合复位下股骨颈动力交叉钉系统(FNS)与空心螺钉(CCS)固定治疗股骨颈骨折的疗效,并探讨其对患者围术期指标和并发症的影响。方法选取2021年1月至2022年1月于陕西省核工业二一五医院骨科就诊的108例股骨颈骨折患者为研究对象,采用双色球随机法分为FNS组和CCS组各54例。FNS组患者给予闭合复位下FNS固定,CCS组给予闭合复位下CCS固定。比较两组患者的手术情况(手术时间、术中出血量、术中透视次数)、术后恢复情况(下地负重时间、住院时间、骨折愈合时间)和术后第12个月时的股骨颈指标(股骨颈短缩长度、颈干角变化)、生活质量[健康状况调查简表(SF-36)],同时比较两组患者术后第6个月、12个月时的髋关节功能[髋关节功能评分表(Harris)]和术后6个月内的并发症发生情况。结果两组患者术中出血量、住院时间比较差异均无统计学意义(P>0.05);FSN组患者手术时间、术中透视次数、下地负重时间、骨折愈合时间分别为(79.21±6.38)min、(9.52±2.32)次、(12.42±3.21)周、(16.19±4.17)周,明显短于CCS组的(83.16±6.52)min、(11.27±3.25)次、(14.64±3.35)周、(18.23±4.39)周,差异均有统计学意义(P<0.05);术后12个月,FNS组患者股骨颈短缩长度、颈干角变化分别为(2.75±1.05)mm、(3.50±1.03)°,明显低于CCS组的(4.18±1.12)mm、(4.29±1.09)°,差异均有统计学意义(P<0.05);术后6个月,两组患者Harris评分比较差异无统计学意义(P>0.05);术后12个月,两组患者Harris评分明显高于术后6个月,差异均有统计学意义(P<0.05),但术后12个月,两组患者的Harris评分、SF-36评分比较差异均无统计学意义(P>0.05);术后6个月内,FSN组患者的并发症总发生率为25.9%,略低于CCS组的38.9%,但差异无统计学意义(P>0.05)。结论闭合复位下FNS和CCS治疗股骨颈骨折均可获得较好的临床治疗效果,但FNS具有手术时间短、术中出血量少、术后恢复快及对患者股骨颈影响较小等优势。

Objective To observe the efficacy of femoral neck system(FNS)and cannulated compression screw(CCS)fixation under closed reduction in the treatment of femoral neck fractures,and explore its effects on peri-operative indicators and complications.Methods A total of 108 patients with femoral neck fractures treated in De-partment of Orthopedics,No.215 Hospital of Shaanxi Nuclear Industry between January 2021 and January 2022 were selected as the study objects.They were divided into FNS group(n=54)and CCS group(n=54)by the two-color ball randomization method.The patients in the FNS group was given FNS fixation under closed reduction,while the pa-tients in the CCS group were given CCS fixation under closed reduction.The surgical conditions(surgical time,intraop-erative blood loss,intraoperative fluoroscopy frequency),postoperative recovery status(time of weight-bearing on the ground,length of hospital stay,fracture healing time),femoral neck indicators(shortened length of femoral neck,change of neck-shaft angle),and quality of life[36-item Short Form of Health Survey(SF-36)]at 12 months after surgery were compared between the two groups,and the hip function[Hip function scale(Harris)]at 6 months and 12 months af-ter surgery and occurrence of complications within 6 months after surgery were compared between the two groups.Results There were no statistically significantly differences in intraoperative blood loss and length of hospital stay be-tween the two groups(P>0.05).The surgical time,intraoperative fluoroscopy frequency,weight-bearing time on the ground and fracture healing time in the FSN group were(79.21±6.38)min,(9.52±2.32)times,(12.42±3.21)weeks,(16.19±4.17)weeks,which were significantly shorter than(83.16±6.52)min,(11.27±3.25)times,(14.64±3.35)weeks,(18.23±4.39)weeks in the CCS group(P<0.05).At 12 months after surgery,the shortened length of femoral neck and change of neck-shaft angle in the FNS group were(2.75±1.05)mm,(3.50±1.03)°,which were significantly lower than(4.18±1.12)mm,(4.29±1.09)°in the CCS group(P<0.05).There was no statistically significant differences in Harris score between the two groups at 6 months after surgery(P>0.05).At 12 months after surgery,the Harris scores in the two groups were significantly higher than those at 6 months after surgery(P<0.05);however,there were no statistically sig-nificnatly differences in Harris score and SF-36 score between the two groups at 12 months after surgery(P>0.05).With-in 6 months after surgery,the total incidence of complications in the FSN group was 25.9%,which was slightly lower than 38.9%in the CCS group,but the difference was not statistically significant(P>0.05).Conclusion Both FNS and CCS under closed reduction can achieve good clinical therapeutic effects in treating femoral neck fractures,but FNS has the advantages of shorter surgical time,less intraoperative blood loss,faster postoperative recovery,and smaller impact on the femoral neck of patients.