股骨颈动力交叉钉系统联合富血小板血浆技术治疗股骨颈骨折的疗效观察

Therapeutic effect of femoral neck system combined with platelet-rich plasma technique in the treatment of femoral neck fractures

目的探讨股骨颈动力交叉钉系统(femoral neck dynamic cross pinning system,FNS)联合富血小板血浆(platelet rich plasma,PRP)技术治疗股骨颈骨折患者的临床疗效。方法回顾性分析2018年6月—2021年6月重庆市第十三人民医院骨科收治的股骨颈骨折患者70例,其中男性36例,女性34例;年龄20~59岁,平均41.6岁;摔伤9例,高空坠落伤40例,道路交通伤21例。根据不同固定方式分为空心钉固定组(22例)、FNS组(30例)及FNS+PRP组(18例),分别给予传统空心钉固定、FNS固定及FNS+PRP治疗(PRP方法:待手术结束后,借助C型臂X线机观察患者骨折端情况,在确定无外展以及旋转等移位后,利用穿刺针针将富血小板血浆注入髋关节骨折断端处,期间至少3侧以上得到注射)。比较三组手术指标、骨折愈合情况、髋关节功能。结果相比空心钉固定组、FNS组,FNS+PRP组完全负重时间、骨折愈合时间较短(P<0.05);FNS+PRP组术后1、3、6、12个月Fernandez-Esteve骨痂评分、Harris评分高于空心钉固定组、FNS组(P<0.05);FNS+PRP组术后1、3、6个月骨保护素、碱性磷酸酶、血清骨钙素均高于空心钉固定组、FNS组(P<0.05);FNS+PRP组并发症发生率(33.33%)低于空心钉固定组(45.45%)、FNS组(40.00%),但差异无统计学意义(χ2=0.212,P=0.644)。结论应用PRP技术对促进FNS治疗股骨颈骨折患者术后恢复具有积极作用,可缩短骨折愈合时间,有助于患者髋功能恢复。

Objective To investigate the clinical efficacy of femoral neck system(FNS)combined with platelet-rich plasma(PRP)in the treatment of femoral neck fractures.Methods Seventy patients with femoral neck fractures admitted to the Department of Orthopedics of the 13th People’s Hospital of Chongqing from Jun.2018 to Jun.2021 were retrospectively analyzed,including 36 male and 34 female.The age ranged from 20 to 59 years,mean 41.6 years.There were 9 cases of falls,40 falls from height and 21 road traffic accidents.According to the adopted fixation methods,patients were divided into hollow nail fixation group(22 cases),FNS group(30 cases)and FNS+PRP group(18 cases).For the last group,PRP was injected into the fracture end of the hip with a puncture needle from at least 3 directions or more after surgery when the C-arm X-ray machine has confirmed no abduction,rotation or other displacement of the fracture end.The operative indexes,fracture healing time and hip function of the three groups were compared.Results Compared with the other two groups,FNS+PRP group showed significantly quicker complete weight-bearing(weeks,7.96±1.03)and fracture healing,much higher Fernandez-Esteve callus score and Harris score at 1,3,6 and 12 months after fixation(P<0.05),and much higher levels of osteoprotegerin,alkaline phosphatase and serum bone Gla-protein at 1,3 and 6 months after surgery(all P<0.05).The incidence of complications in FNS+PRP group was 33.33%,lower than that in hollow nail fixation group(45.45%)and FNS group(40.00%),but the difference was not statistically significant(χ2=0.212,P=0.644).Conclusion The application of PRP has positive effects on femoral neck fractures fixed by FNS,which quickens fracture healing and promotes hip functional recovery.