空心加压螺钉联合内侧支撑钢板对Pauwells Ⅲ型股骨颈骨折患者的应用及对患者下肢功能的影响

Application of Cannulated Compression Screws Combined with Medial Support Plate in Pauwells Ⅲ Type Femoral Neck Fractures and Its Impact on Lower Limb Function

目的:探讨空心加压螺钉联合内侧支撑钢板对Pauwells Ⅲ型股骨颈骨折患者的应用及对患者下肢功能影响。方法:将本院2017年4月至2022年8月收治的Pauwells Ⅲ型股骨颈骨折患者82例随机分为观察组与对照组各41例。对照组采用常规的空心加压螺钉固定治疗,观察组在此基础上联合内侧支撑钢板固定术治疗,对比两组患者围术期相关指标,髋关节功能(Hip function, Harris)评分,下肢功能以及术后近远期并发症发生率。结果:观察组患者骨折愈合时间明显短于对照组,手术时间、术中出血量、术后引流量、住院时间明显高于对照组(P<0.05);两组患者术后3 d Harris评分中关节疼痛、功能、活动分数对比无明显差异(P>0.05),术后3个月两组患者Harris评分中关节疼痛评分降低,观察组更低,功能、活动评分升高,观察组更高(P<0.05);两组患者术后3 d步长、步频、步行速度对比无明显差异(P>0.05),术后3个月和6个月步长、步频、步行速度明显提高,且观察组更高(P<0.05);观察组并发症发生率4.87%,明显低于对照组26.83%(P<0.05),且观察组慢性疼痛发生率4.87%,明显低于对照组19.51%(P<0.05)。结论:空心加压螺钉联合内侧支撑钢板对Pauwells Ⅲ型股骨颈骨折患者治疗效果显著,能够改善患者远期髋关节功能和下肢功能,减少术后并发症发生率,且同时能够减轻患者术后慢性疼痛情况的发生,值得临床应用推广。

Objective:To investigate the application of cannulated compression screws combined with medial support plate in treating Pauwells Ⅲ type femoral neck fractures and its impact on lower limb function.Methods:From April 2017 to August 2022,82 patients with Pauwells Ⅲ type femoral neck fractures admitted to our hospital were randomly allocated into an observation group and a control group(41 cases each).The control group received conventional cannulated compression screw fixation,while the observation group underwent additional medial support plate fixation.Perioperative indicators,Harris hip function scores,lower limb function,and short-and long-term postoperative complication rates were compared between the two groups.Results:The fracture healing time in the observation group was significantly shorter than in the control group,with longer surgical duration,more intraoperative blood loss,greater postoperative drainage volume,and extended hospital stay(P<0.05).No significant differences were observed in pain,function,and activity scores of the Harris hip function at postoperative day 3 between the two groups(P>0.05).However,at 3 months postoperatively,the pain score was lower and function and activity scores were higher in the observation group(P<0.05).No significant differences were found in stride length,cadence,or walking speed at postoperative day 3(P>0.05),but these parameters significantly improved at 3 and 6 months postoperatively,with better outcomes in the observation group(P<0.05).The complication rate was significantly lower in the observation group(4.87%)compared to the control group(26.83%,P<.05),and the incidence of chronic pain was also notably less in the observation group(4.87%vs.19.51%,P<.05).Conclusion:The combination of cannulated compression screws and medial support plates is efficacious for Pauwells Ⅲ type femoral neck fractures,improving long-term hip joint function and lower limb function,reducing postoperative complication rates,and alleviating postoperative chronic pain.This approach is worthy of clinical promotion.