股骨颈动力抗旋交叉钉系统与空心螺钉治疗伴后内侧壁粉碎的股骨颈骨折疗效比较

Comparison of effectiveness of femoral neck system and cannulate compression screw in treatment of femoral neck fracture with comminuted posterior medial wall

目的 探讨采用股骨颈动力抗旋交叉钉系统(femoral neck system,FNS)与空心螺钉倒三角固定治疗伴后内侧壁粉碎的股骨颈骨折患者的临床疗效。方法 回顾性分析安徽省阜阳市人民医院2019年12月至2021年8月采用FNS与空心螺钉倒三角固定方法治疗伴后内侧壁粉碎的新鲜的股骨颈骨折患者,根据内固定方式分为两组:采用FNS固定(FNS组,21例)及采用3枚空心螺钉倒三角固定(空心螺钉组,22例)。其中,男19例,女24例,年龄18~59岁。观察指标包括:术中透视次数、手术时间、Garden指数、Haidukewych标准评分、皮质支撑情况、骨折愈合时间、完全负重时间、股骨颈短缩长度、内固定失效率及股骨头坏死情况。结果 两组患者术后随访12~24个月,平均(18.60±4.10)个月。两组术中透视次数FNS组少于空心螺钉组,差异有统计学意义(P<0.05);但两组的手术时间、Garden指数、Haidukewych标准评分、皮质支撑情况等比较,差异无统计学意义(P>0.05)。两组的骨折愈合时间、术后末次髋关节Harris评分比较,差异无统计学意义(P>0.05),术后两组患者的手术切口均Ⅰ期愈合;空心螺钉组出现1例内固定失效,空心螺钉切出、退钉,骨折再移位,髋内翻畸形;FNS组的术后完全负重时间、股骨颈短缩长度、股骨头坏死发生率优于空心螺钉组,且差异具有统计学意义(P<0.05)。结论 对于伴有后内侧壁粉碎的股骨颈骨折,FNS固定能减少术中透视及股骨颈短缩,有利于患者早期负重活动,且在早期随访中股骨头坏死率更低。

Objective To explore the comparison of clinical efficacy between femoral neck system(FNS) and hollow screw inverted triangle fixation for femoral neck fracture patients with comminuted posterior medial wall.Methods From December 2019 to August 2021,fresh femoral neck fracture patients with comminuted posterior medial wall were treated by FNS(FNS group,21 cases) and cannulated screw inverted triangle fixation(cannulated compression screw group,22cases) in Fuyang People's Hospital.There were 19 males and 24 females,aged from 18-59 years.The observation indexes included intraoperative fluoroscopy,operation time,Garden index,Haidukewych standard score,cortical support,the fracture healing time,the time of full weight-bearing,femoral neck shortening length,failure of internal fixation and the occurrence of femoral head necrosis.Results The postoperative follow-up of the two groups was 12-24 months,with an average of(18.60±4.10) months.There was a significant difference in the frequency of intraoperative fluoroscopy between the two groups(P<0.05).There was no significant difference in operation time,Garden index,Haidukewych score and cortical support between the two groups(P>0.05).There was no significant difference in fracture healing time and Harris hip score between the two groups(P>0.05).The incisions of both groups healed first after surgery.In the cannulated screw group,there was 1 case of internal fixation failure,cannulated screw cutting,nail withdrawal,fracture displacement and coxa vara deformity.The FNS group was superior to the cannulated compression screw group in the time of full weightbearing,femoral neck shortening,and femoral head necrosis rate(P<0.05).Conclusion For femoral neck fractures with posterior medial wall comminuted,FNS fixation can reduce intraoperative fluoroscopy and femoral neck shortening,facilitate early weight-bearing activities,and lower the rate of femoral head necrosis in early follow-up.