股骨颈动力交叉钉系统与空心拉力螺钉治疗中青年股骨颈骨折的疗效比较

Femoral neck system and cannulated compression screw fixation in the treatment of femoral neck fracture in the young and middle‑aged patients:efficacy comparison

目的比较股骨颈动力交叉钉系统(FNS)与空心拉力螺钉(CCS)治疗中青年股骨颈骨折的疗效。方法采用回顾性队列研究分析2020年7月至2021年12月福州市第二医院收治的91例中青年股骨颈骨折患者的临床资料,其中男52例,女39例;年龄23~65岁[(48.9±10.3)岁]。GardenⅠ型31例,GardenⅡ型9例,GardenⅢ型12例,GardenⅣ型39例。PauwelsⅠ型7例,PauwelsⅡ型33例,PauwelsⅢ型51例。53例行FNS内固定治疗(FNS组),38例行CCS内固定治疗(CCS组)。比较两组手术时间、术中出血量、Haidukewych复位质量、住院时间、Barthel指数、骨折愈合时间、负重时间;术后3个月、6个月、1年及末次随访时髋关节功能Harris评分;并发症发生率和二次手术率。结果患者均获随访15~31个月[(22.2±5.5)个月]。两组手术时间、Haidukewych复位质量、住院时间、Barthel指数差异无统计学意义(P均>0.05)。FNS组术中出血量为50.0(20.0,85.0)ml,多于CCS组的20.0(10.0,50.0)m(l P<0.01)。FNS组骨折愈合时间、部分负重时间和完全负重时间分别为4.0(3.0,5.0)个月、3.0(2.0,3.0)个月、5.0(4.5,6.0)个月,短于CCS组的6.0(5.0,7.0)个月、3.0(2.8,4.0)个月、6.0(6.0,7.0)个月(P均<0.01)。FNS组术后3个月、6个月、1年及末次随访时Harris评分分别为74.0(71.0,77.0)分、87.0(84.0,88.5)分、91.0(88.0,95.0)分、94.0(91.0,96.0)分,高于CCS组的73.0(70.0,74.0)分、82.5(79.8,87.0)分、88.0(83.5,91.0)分、89.0(84.0,93.0)分(P<0.05或0.01)。两组并发症发生率和二次手术率差异无统计学意义(P均>0.05)。结论与CCS比较,FNS治疗中青年股骨颈骨折虽术中出血量较多,但可缩短骨折愈合时间,使患者尽早完全负重,明显改善髋关节功能。

Objective To compare the efficacy of femoral neck system(FNS)and cannulated compression screw(CCS)in the treatment of femoral neck fracture in the young and middle‑aged patients.Methods A retrospective cohort study was conducted to analyze the clinical data of 91 patients with femoral neck fracture admitted to Fuzhou Second Hospital from July 2020 to December 2021,including 52 males and 39 females;aged 23‑65 years[(48.9±10.3)years].Garden classification of the fracture found that 31 patients were with type I,9 with type II,12 with type III and 39 with type IV.Pauwels classification of the fracture found that 7 patients were with type I,33 with type II and 51 with type III.A total of 53 patients were treated with FNS fixation(FNS group)and 38 patients with CCS fixation(CCS group).The operation time,intraoperative blood loss,Haidukewych fracture reduction quality,hospitalization time,Barthel index,fracture healing time,and weight‑bearing time were compared between the two groups.The hip function was assessed by Harris hip score in both groups at postoperative 3 months,6 months and 1 year and at the final follow‑up.The incidences of postoperative complication and secondary surgery were also compared between the two groups.Results All the patients were followed up for 15‑31 months[(22.2±5.5)months].There were no significant differences in the operation time,Haidukewych fracture reduction quality,hospitalization time,or Barthel index(all P>0.05).The intraoperative blood loss in the FNS group was 50.0(20.0,85.0)ml,which was more than that in the CCS group[20.0(10.0,50.0)ml](P<0.01).The fracture healing time,partial weight‑bearing time,and full weight‑bearing time in the FNS group[4.0(3.0,5.0)months,3.0(2.0,3.0)months,5.0(4.5,6.0)months]were shorter than those in the CCS group[6.0(5.0,7.0)months,3.0(2.8,4.0)months,6.0(6.0,7.0)months](all P<0.01).The Harris hip score at postoperative 3 months,6 months and 1 year and at the final follow‑up were 74.0(71.0,77.0)points,87.0(84.0,88.5)points,91.0(88.0,95.0)points,and 94.0(91.0,96.0)points in the FNS group,significantly higher than those in the CCS group[73.0(70.0,74.0)points,82.5(79.8,87.0)points,88.0(83.5,91.0)points,89.0(84.0,93.0)points](all P<0.05 or 0.01).There were no statistically significant differences in the incidences of postoperative complication or secondary surgery between the two groups(all P>0.05).Conclusion Compared with CCS,FNS can shorten fracture healing time,allow patients to carry full weight as soon as possible,and significantly improve hip function in the treatment of middle‑aged and young adults with femoral neck fracture,although there is more intraoperative blood loss.