InterTan内固定治疗PauwelsⅢ型股骨颈骨折临床疗效分析

Effect analysis of internal fixation of InterTan for femoral neck fractures with PauwelsⅢ

目的探讨InterTan内固定治疗PauwelsⅢ型股骨颈骨折的临床效果。方法回顾性分析2018年1月至2019年12月我院治疗的83例PauwelsⅢ型股骨颈骨折患者的临床资料,按手术方式分为两组,分别采用InterTan固定(InterTan组,43例)和空心钉固定(空心钉组,40例)。结果InterTan组切口长度、失血量均大于空心钉组,髋关节Harris功能评分优于空心钉组(P<0.05),而两组手术时间、住院时间、骨折愈合时间及复位质量满意率比较均无统计学差异(P>0.05)。两组患者随访24~48个月,平均(35.81±6.75)个月。术后两组均无外侧壁骨折发生。InterTan组发生股骨头坏死3例,骨折不愈合2例,无内固定失效及退钉发生,空心钉组出现退钉18例,内固定失效3例,股骨头坏死4例,骨折不愈合3例;空心钉组退钉率和并发症率均明显高于InterTan组,差异有统计学意义(P<0.05)。结论InterTan内固定治疗PauwelsⅢ型股骨颈骨折,固定可靠,术后髋关节功能恢复良好,明显减少术后螺钉退出的发生,可作为不稳定股骨颈骨折的首选治疗方案。

Objective To explore the effect of InterTan internal fixation in the treatment of femoral neck fractures with PauwelsⅢ.Method A total of 83 patients with Pauwels typeⅢfemoral neck fracture treated in our hospital from January 2018 to December 2019 were enrolled and divided into two groups according to surgical methods,including 43 cases of InterTan fixation group and 40 cases of cannulated screw fixation group.Results The length of incision was longer,the volume of blood loss was more,but Harris score was higher in the InterTan fixation group than those in the cannulated screw fixation group,and the differences were statistically significant(P<0.05).There were no significant differences in the operation time,hospital stays,fracture healing time and satisfaction rate of reduction quality between the two groups(P>0.05).All cases were followed up for 24 to 48 months with an average of 35.81±6.75 months.No lateral wall fractures occurred in both groups after the surgery.There were 3 cases of femoral head necrosis and 2 cases of fracture nonunion in the InterTan fixation group without internal fixation failure and nail withdrawal,and 18 cases of unscrewing,3 cases of internal fixation failure,4 cases of femoral head necrosis and 3 cases of fracture nonunion in the cannulated screw fixation group.The nail withdrawal rate and the complication rate of the cannulated screw group were significantly higher than those of the InterTan fixation group(P<0.05).Conclusion Internal fixation of InterTan can achieve firm fixation and ideal hip function recovery and reduce the incidence of complication(as nail withdraw-al)for PauwelsⅢfemoral neck fractures,and it can be a preferred choice for unstable femoral neck fracture.