股骨颈动力交叉钉系统与空心螺钉固定治疗65~75岁年龄段患者股骨颈骨折的效果比较

Comparison of femoral neck system and cannulated compression screws in the fixation of femoral neck fractures in the elderly patients aged 65 to 75 years old

目的比较股骨颈动力交叉钉系统(FNS)与空心螺钉(CCS)固定治疗65~75岁年龄段患者股骨颈骨折的临床效果。方法回顾性分析2015年1月至2022年9月期间青岛大学附属医院创伤外科收治的39例65~75岁年龄段股骨颈骨折患者资料。按内固定方式不同分为两组:FNS组18例,男8例,女10例;年龄(71.1±2.8)岁;采用FNS固定治疗。CCS组21例,男7例,女14例;年龄(70.1±2.9)岁;采用CCS固定治疗。比较两组患者的术中透视次数、手术时间、术中出血量、住院费用、骨折愈合时间、内固定失败情况,以及术后1年髋关节Harris评分、颈干角变化、股骨颈短缩程度。结果两组患者术前一般资料及随访时间比较差异均无统计学意义(P>0.05),具有可比性。FNS组患者的术中透视次数[(15.1±2.3)次]显著少于CCS组患者[(19.5±3.5)次]、手术时间[(49.2±5.2) min]显著短于CCS组患者[(62.4±11.2)min],术中出血量[(74.2±15.6) mL]、住院费用[(39 928.7±1 438.3)元]显著多于CCS组患者[(53.1±17.3)mL、(23 527.9±2 126.3)元],差异均有统计学意义(P<0.05)。而两组患者的骨折愈合时间比较差异无统计学意义(P>0.05)。FNS组患者术后1年颈干角减小角度(2.65°±1.66°)、股骨颈短缩程度[(3.9±1.3)mm]均显著小于CCS组患者[4.18°±2.13°、(6.3±2.5)mm],髋关节Harris评分[(82.2±7.2)分]显著高于CCS组患者[(76.4±5.9)分],差异均有统计学意义(P<0.05)。FNS组和CCS组分别有1、4例患者发生内固定失败,差异无统计学意义(P>0.05)。结论与CCS比较,FNS固定治疗65~75岁年龄段患者股骨颈骨折的疗效更好,但也要考虑内固定失败的发生风险。

Objective To compare the therapeutic efficacy between femoral neck system(FNS)and cannulated compression screws(CCS)in the fixation of femoral neck fractures in the elderly patients aged 65 to 75 years old.Methods A retrospective study was conducted to analyze the data of 39 patients aged 65 to 75 years old who had been treated for femoral neck fractures at Department of Trauma Surgery,Hospital Affiliated to Qingdao University from January 2015 to September 2022.The patients were divided into 2 groups according to their internal fixation methods.In the FNS group of 18 cases subjected to FNS fixation,there were 8 male and 10 females with an age of(71.1±2.8)years.In the CCS group of 21 cases subjected to CCS fixation,there were 7 males and 14 females with an age of(70.1±2.9)years.The 2 groups were compared in terms of intraoperative fluoroscopy frequency,surgical time,intraoperative bleeding,hospitalization costs,fracture healing time,internal fixation failure,and Harris hip score,changes in neck shaft angle,and femoral neck shortening at 1 year after surgery.Results The differences were not statistically significant in the preoperative general data or follow-up time between the 2 groups,indicating comparability(P>0.05).In the FNS group,the intraoperative fluoroscopy frequency[(15.1±2.3)times]was significantly lower than that in the CCS group[(19.5±3.5)times],the surgical time[(49.2±5.2)minutes]was significantly shorter than that in CCS group[(62.4±11.2)minutes],and the intraoperative bleeding[(74.2±15.6)mL]and hospitalization costs[(39,928.7±1,438.3)yuan]were significantly higher than those in the CCS group[(53.1±17.3)mL and(23,527.9±2,126.3)yuan](all P<0.05).The difference in fracture healing time was not statistically significant between the 2 groups(P>0.05).In the FNS group,the decreased neck shaft angle(2.65°±1.66°)and femoral neck shortening(3.9±1.3 mm)were significantly smaller than those in the CCS group[4.18°±2.13°and(6.3±2.5)mm]at 1 year after surgery,and the Harris hip score[(82.2±7.2)points]was significantly higher than that in the CCS group[(76.4±5.9)points](all P<0.05).Internal fixation failure occurred in 1 case in the FNS group and in 4 cases in the CCS group,respectively,showing no statistically significant difference(P>0.05).Conclusions Compared with CCS fixation,FNS fixation may lead to better therapeutic efficacy in patients with femoral neck fracture aged 65 to 75 years old.However,the risk of internal fixation failure should also be taken into consideration.