髋外侧分区法植入前置针在股骨颈骨折经皮空心螺钉内固定术中的应用

Application of pre-inserting a needle via lateral hip zoning method in the surgery of percutaneous hollow screw internal fixation for treatment of femoral neck fractures

目的:探讨髋外侧分区法植入前置针在股骨颈骨折经皮空心螺钉内固定术中的应用价值。方法:回顾性分析2018年3月至2022年3月收治的60例采用经皮空心螺钉内固定术治疗的股骨颈骨折患者的病例资料,其中采用髋外侧分区法植入前置针辅助植入空心螺钉者纳入髋外侧分区组,依据经验植入空心螺钉者纳入传统组。比较2组患者的术中X线透视次数、手术时间、术中钻孔次数、骨折愈合时间和末次随访时的Harris髋关节评分。结果:髋外侧分区组和传统组各有1例患者因股骨头坏死行髋关节置换而退出。髋外侧分区组的术中X线透视次数、手术时间、术中钻孔次数、骨折愈合时间的评价结果均优于传统组[(10.5±2.3)次,(25.4±7.3)次,t=7.657,P=0.011;(41.7±5.6)min,(55.7±15.6)min,t=4.576,P=0.015;(4.5±1.2)次,(14.5±2.1)次,t=16.756,P=0.021;(5.6±1.5)个月,(7.0±0.6)个月,t=5.987,P=0.032]。2组患者末次随访时的Harris髋关节评分比较,差异无统计学意义[(90.3±2.7)分,(90.1±1.2)分,t=1.205,P=0.301]。结论:在股骨颈骨折经皮空心螺钉内固定术中,采用髋外侧分区法植入前置针辅助植入空心螺钉与凭经验植入空心螺钉相比,两者的髋关节功能恢复程度相当,但前者术中X线透视次数和钻孔次数少、手术时间和骨折愈合时间短。

Objective:To explore the applied value of pre-inserting a needle via lateral hip zoning method in the surgery of percutaneous hollow screw internal fixation for treatment of femoral neck fractures(FNFs).Methods:The medical records of 60 patients who underwent percutaneous hollow screw internal fixation for FNFs from March 2018 to March 2022 were analyzed retrospectively.The patients who received pre-insertion of a needle via lateral hip zoning method for assisting hollow screw implantation were assigned into the lateral hip zoning group,while the ones who underwent implantation of hollow screw based on the surgeon’s experiences into the tradition group.The intraoperative X-ray exposure,operative time,intraoperative drilling times,fracture healing time and Harris hip score evaluated at the last follow-up were recorded and compared between the 2 groups.Results:One patient withdrew from each group due to undergoing hip replacement for femoral head necrosis.The results of evaluation on intraoperative X-ray exposure,operative time,intraoperative drilling times and fracture healing time were better in lateral hip zoning group compared to tradition group(10.5±2.3 vs 25.4±7.3 times,t=7.657,P=0.011;41.7±5.6 vs 55.7±15.6 minutes,t=4.576,P=0.015;4.5±1.2 vs 14.5±2.1 times,t=16.756,P=0.021;5.6±1.5 vs 7.0±0.6 months,t=5.987,P=0.032);while,the comparison of Harris hip score evaluated at the last follow-up between the 2 groups revealed no significant differences(90.3±2.7 vs 90.1±1.2 points,t=1.205,P=0.301).Conclusion:Implantation of hollow screws assisted by pre-inserting a needle via lateral hip zoning method is similar to implantation of hollow screws based on the surgeon’s experiences in the degree of hip function recovery in percutaneous hollow screw internal fixation for treatment of FNFs;while the former displays the advantages of fewer intraoperative X-ray exposure and intraoperative drilling,shorter operative time and fracture healing time compared to the latter.