机器人辅助股骨颈动力交叉钉系统联合空心加压螺钉治疗青壮年股骨颈骨折的近期疗效

Short-term effectiveness of robot-guided femoral neck system combined with cannulated compression screw fixation in treatment of femoral neck fracture in young and middle-aged patients

目的探讨机器人辅助股骨颈动力交叉钉系统(femoral neck system,FNS)联合空心加压螺钉(cannulated compression screw,CCS)治疗青壮年股骨颈骨折患者的近期疗效。方法回顾分析2021年1月—2023年6月收治且符合选择标准的49例青壮年股骨颈骨折患者临床资料。股骨颈骨折复位后,机器人辅助下采用FNS内固定27例(FNS组)、FNS联合CCS内固定22例(FNS+CCS组)。两组患者性别、年龄、致伤原因、骨折至手术时间、骨折侧别及分型(Garden分型及Pauwels分型)等基线资料比较,差异均无统计学意义(P>0.05)。记录两组手术时间、术中出血量及透视次数、患者开始负重时间、末次随访时髋关节疼痛及功能评分(VAS评分以及Harris评分);影像学复查评价骨折复位质量、骨折愈合情况以及骨折不愈合、股骨头坏死、股骨颈短缩发生情况。结果两组手术均顺利完成,术后切口Ⅰ期愈合。两组手术时间、术中出血量差异无统计学意义(P>0.05),但FNS+CCS组术中透视次数多于FNS组(P<0.05)。两组患者均获随访,随访时间12~18个月,平均14.1个月。影像学复查示,两组骨折复位质量差异无统计学意义(P>0.05),但FNS+CCS组骨折愈合时间较FNS组缩短、开始负重更早(P<0.05);FNS+CCS组患者股骨颈短缩、骨折不愈合以及股骨头坏死发生率均低于FNS组,其中股骨颈短缩发生率组间差异有统计学意义(P<0.05)。末次随访时,两组VAS评分差异无统计学意义(P>0.05),但FNS+CCS组Harris评分优于FNS组(P<0.05)。结论机器人导航FNS联合CCS内固定治疗青壮年股骨颈骨折,与单纯FNS内固定相比,在早期负重、骨折愈合方面存在明显优势,能提高骨折愈合率,有效防止术后并发症的发生,获得较好近期疗效。

Objective To investigate short-term effectiveness of robot-guided femoral neck system(FNS)combined with cannulated compression screw(CCS)fixation in treatment of femoral neck fracture in young and middle-aged patients.Methods A clinical data of 49 young and middle-aged patients with femoral neck fractures,who met the selection criteria and admitted between January 2021 and June 2023,was retrospectively analyzed.After reduction of femoral neck fractures,27 cases were treated with robot-guided FNS fixation(FNS group)and 22 cases with robot-guided FNS and CCS fixation(FNS+CCS group).There was no significant difference in baseline data such as gender,age,cause of fracture,time from fracture to operation,fracture side,and classification(Garden classification and Pauwels classification)between the two groups(P>0.05).The operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,the time when the patient began bearing weight,and hip joint pain and functional scores(VAS score and Harris score)at last follow-up for two groups were recorded.Imaging re-examination was taken to evaluate the quality of fracture reduction,fracture healing,as well as the occurrence of fracture non-union,osteonecrosis of the femoral head,and femoral neck shortening.Results All operations were successfully completed and the incisions healed by first intention.There was no significant difference in operation time and intraoperative blood loss between the two groups(P>0.05),and the intraoperative fluoroscopy frequency in FNS+CCS group significantly increased compared to FNS group(P<0.05).All patients were followed up 12-18 months(mean,14.1 months).Imaging re-examination showed that there was no significant difference in fracture reduction quality between the two groups(P>0.05),but the fracture healing time was significantly shorter in FNS+CCS group than in FNS group,and weight-bearing began earlier(P<0.05).The incidences of femoral neck shortening,fracture non-union,and osteonecrosis of the femoral head were lower in FNS+CCS group than in FNS group,and there was significant difference in the incidence of femoral neck shortening between groups(P<0.05).At last follow-up,there was no significant difference in VAS scores between the two groups(P>0.05).However,the Harris score was significantly higher in FNS+CCS group than in FNS group(P<0.05).Conclusion Compared with FNS fixation alone,robot-guided FNS combined with CCS fixation in the treatment of femoral neck fractures in young and middle-aged patients has obvious advantages in terms of early weight bearing and fracture healing,improves fracture healing rate,effectively prevents postoperative complications,and can obtain good short-term effectiveness.