横向松质骨拉力螺钉在中青年PauwelsⅢ型股骨颈骨折内固定中的应用效果分析

Clinical Efficacy of Transverse Cancellous Lag Screw Fixation in the Treatment of PauwelsⅢType Femoral Neck Fracture in Young and Middle-aged Patients

目的分析横向松质骨拉力螺钉在中青年PauwelsⅢ型股骨颈骨折内固定中的应用效果。方法选取2018年2月至2022年2月焦作市第二人民医院收治的72例中青年PauwelsⅢ型股骨颈骨折患者作为研究对象,按照不同手术方式将其分为拉力螺钉组(35例)和空心螺钉组(37例),拉力螺钉组患者行闭合复位横向松质骨拉力螺钉内固定治疗,空心螺钉组患者行闭合复位普通空心螺钉内固定治疗,对比观察两组患者围手术期相关指标、骨折愈合时间、疼痛程度、髋关节功能及不良事件发生情况。结果拉力螺钉组患者手术时间、术中出血量、住院时间与空心螺钉组无明显差异(t=0.954、0.471、0.836,P=0.343、0.639、0.406),而术后开始负重时间明显长于空心螺钉组(t=3.568,P<0.001)、骨折愈合时间明显短于空心螺钉组(t=4.804,P<0.001)。术后3、6个月,拉力螺钉组患者视觉模拟评分法(VAS)评分均明显低于空心螺钉组(t=3.052、5.832,P=0.003、P<0.001)、Harris评分均明显高于空心螺钉组(t=5.280、5.185,P均<0.001)。拉力螺钉组患者术后不良事件发生率为2.86%,与空心螺钉组患者的术后不良事件发生率10.81%无明显差异(χ^(2)=1.761,P=0.185)。结论与普通空心螺钉内固定相比,横向松质骨拉力螺钉内固定更能明显缩短中青年PauwelsⅢ型股骨颈骨折患者骨折愈合时间,缓解患者疼痛程度,改善患者髋关节功能。

Objective To analyze the clinical efficacy of transverse cancellous lag screws fixation in the treatment of PauwelsⅢtype femoral neck fracture in young and middle-aged patients.Methods 72 young and middle-aged patients with PauwelsⅢtype femoral neck fracture,admitted to Jiaozuo Second People’s Hospital from February 2018 to February 2022,were enrolled as research subjects and divided into lag screw group(n=35)and cannulated screw group(n=37).Patients in the lag screw group were treated with closed reduction and internal fixation using transverse cancellous lag screw,whereas patients were treated with closed reduction and internal fixation using standard cannulated screw in the cannulated screw group.Perioperative related indicators,fracture healing time,pain degree,hip joint function,and the occurrence of adverse events of patients were compared between the two groups.Results There were no significant differences between the lag screw group and the cannulated screw group in terms of operation time,intraoperative blood loss,and length of stay(t=0.954,0.471 and 0.836,P=0.343,0.639 and 0.406),whereas postoperative weight-bearing starting time was prominently earlier(t=3.568,P<0.001)and the fracture healing time was significantly shorter(t=4.804,P<0.001)in the lag screw group.Three and six months after surgery,the visual analogue scale(VAS)scores of patients were significantly lower(t=3.052 and 5.832,P=0.003,P<0.001),and the Harris scores of patients were prominently higher(t=5.280 and 5.185,both P<0.001)in the lag screw group.The incidence of postoperative adverse reactions was 2.86%in the lag screw group,which showed no significant difference compared with the corresponding 10.81%in the cannulated screw group(χ^(2)=1.761,P=0.185).Conclusion Compared with the internal fixation using standard cannulated screws,the internal fixation using transverse cancellous lag screw can significantly shorten the fracture healing time of young and middle-aged patients with PauwelsⅢtype femoral neck fracture,alleviate their pain and improve their hip joint functions.