PauwelsⅢ型股骨颈骨折患者应用“F”形空心钉内固定术的治疗效果

Effect of Internal Fixation with"F"Shaped Hollow Nail in Patients with Pauwels TypeⅢFemoral Neck Fracture

目的:探究应用“F”形空心钉内固定术治疗PauwelsⅢ型股骨颈骨折患者的效果。方法:回顾性分析2018年9月—2020年9月于龙岩市中医院接受空心钉内固定手术治疗的68例PauwelsⅢ型股骨颈骨折患者的临床资料,按照空心钉置入方式的不同分为“F”形组(n=36)和平行组(n=32)。“F”形组应用“F”形空心钉内固定术治疗,平行组应用倒三角3枚平行空心钉内固定治疗,术后两组均随访12个月。比较两组患者的手术相关指标(住院时间、术后开始负重时间、骨折愈合时间)和骨折复位质量满意度(Garden对线指数),记录术前和末次随访的髋关节情况[伸-屈关节活动度(ROM)、疼痛视觉模拟评分法(VAS)评分、Harris髋关节功能量表(Harris)评分]和随访期间并发症的发生情况。结果:“F”形组住院时间短于平行组,术后开始负重时间、骨折愈合时间均早于平行组,差异有统计学意义(P<0.05)。“F”形组骨折复位质量满意度为97.22%,高于平行组的81.25%,差异有统计学意义(P<0.05)。两组末次随访的ROM大于手术前,Harris评分高于手术前,VAS评分低于手术前,差异有统计学意义(P<0.05);且“F”形组的ROM、Harris评分、VAS评分均优于平行组,差异有统计学意义(P<0.05)。“F”形组术后并发症总发生率为19.44%,低于平行组的53.13%,差异有统计学意义(P<0.05)。结论:相比于传统的倒三角3枚平行空心钉内固定术,应用“F”形空心钉内固定术对PauwelsⅢ型股骨颈骨折患者有更加显著的治疗效果,可有效地改善手术相关指标,提高复位质量满意度,恢复髋关节功能,减少术后并发症的发生。

Objective:To investigate the effect of internal fixation with"F"shaped hollow nail on Pauwels typeⅢfemoral neck fracture.Method:Retrospective analysis was made on the clinical data of 68 patients with Pauwels typeⅢfemoral neck fracture who received internal fixation with hollow nails in Longyan Hospital of Traditional Chinese Medicine from September 2018 to September 2020.They were divided into"F"shape group(36 cases)and parallel group(32 cases)according to the different placement methods of hollow nails.The"F"shape group was treated with internal fixation with"F"shaped hollow nails,and the parallel group was treated with internal fixation with three inverted triangular parallel hollow nails.The patients in both groups were followed up for 12 months after surgery.The operation related indexes(length of stay,time of starting weight bearing after operation,time of fracture healing)and satisfaction with fracture reduction quality(Garden alignment index)of the two groups of patients were compared,and the hip joint conditions[extension-flexor range of motion(ROM),pain visual analogue scale(VAS)score,Harris hip function scale(Harris)score]before operation and at the last follow-up,as well as the occurrence of complications during the follow-up were recorded.Result:The length of stay in the"F"shape group was shorter than that in the parallel group,the time of starting weight bearing and fracture healing time of were earlier than those of the parallel group,the differences were statistically significant(P<0.05).The satisfaction of fracture reduction quality in the"F"shape group was 97.22%,which was higher than 81.25%in the parallel group,the difference was statistically significant(P<0.05).At the last follow-up,the ROM of the two groups was greater than before operation,the Harris score was higher than before operation,and the VAS score was lower than before operation,the differences were statistically significant(P<0.05);the ROM,Harris score and VAS score of the"F"shape group were better than those of the parallel group,the differences were statistically significant(P<0.05).The total incidence of postoperative complications in the"F"shape group was 19.44%,which was lower than 55.13%in the parallel group,the difference was statistically significant(P<0.05).Conclusion:Compared with the traditional internal fixation with three inverted triangular parallel hollow nails,the application of hollow nail"F"shaped internal fixation in Pauwels typeⅢfemoral neck fracture has a more significant therapeutic effect,which can effectively improve the surgical related indicators,improve the satisfaction of reduction quality,restore hip joint function,and reduce the incidence of postoperative complications.