空心螺钉联合三维蜂窝导向器定位植钉治疗老年股骨颈骨折的临床效果

Effects of cannulated screw combined with three-dimensional honeycomb guide in the treatment of elderly patients with femoral neck fractures

目的 探讨空心螺钉联合不同定位植钉策略治疗老年股骨颈骨折对螺钉植入精准性、髋关节功能(Harris)评分及并发症的影响。方法 选取2017年4月至2021年4月我院收治的104例老年股骨颈骨折病人,根据随机数表法分为A组和B组,每组各52例。2组均行经皮空心螺钉内固定术,B组采取徒手定位植钉,A组采取新型三维蜂窝导向器辅助定位植钉。比较2组围术期指标、影像学指标、应激激素、Harris评分、VAS评分及并发症发生情况。结果 A组螺钉植入精准性优于B组,导针穿刺次数少于B组(P<0.05);术后即刻,A组螺钉间平行度、螺钉与颈轴向偏离度、螺钉覆盖面积低于B组,螺钉间距大于B组(P<0.01);术后1 d,A组血清皮质醇、去甲肾上腺素水平低于B组(P<0.05);2组Harris、VAS评分及并发症发生率比较,差异无统计学意义(P>0.05)。结论 新型三维蜂窝导向器辅助定位植钉、徒手植钉在老年股骨颈骨折治疗中效果相当,前者有助于提高螺钉植入精准性,改善影像学指标,且对应激反应影响小。

Objective To investigate the effect of cannulated screw combined with different positioning screw implantation strategies on the accuracy of screw implantation,hip function score(Harris) and the complications in the treatment of femoral neck fractures in the elderly.Methods A total of 104 elderly patients with femoral neck fractures admitted to our hospital from April 2017 to April 2021 were enrolled and divided into two groups by random number table method,with 52 patients in each group.All patients underwent percutaneous hollow screw internal fixation,and the patients receiving freehand positioning of the nail implant were divided into group B and those receiving new 3D foveal guide assisted positioning of the nail implant were divided into group A.The data of perioperative indexes,imaging indexes,stress hormones,Harris score,visual analogue scale(VAS) score and the complications were collected and compared between the two groups.Results The accuracy rate of screw implantation was significantly higher and the number of guiding needle punctures was significantly lower in group A than those in group B(P<0.05).Immediately after operation,the parallelism between screws,the axial deviation between screws and neck and the screw coverage area in group A were lower than those in group B,and the distance between screws was greater than that in group B(P<0.01).The serum levels of cortisol and norepinephrine in group A were lower than those in group B 1 d after operation(P<0.05).There was no significant difference in Harris and VAS scores between the two groups before operation,6 months and 12 months after operation(P>0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusions The new three-dimensional honeycomb guide-assisted positioning of the screw and the free-hand screw implantation show similar effects in the treatment of femoral neck fractures in the elderly patients.The former helps to improve the accuracy of screw implantation and imaging indicators,with less stress response.