空心加压螺钉与股骨颈动力交叉钉治疗成人股骨颈骨折的疗效比较

Comparison of therapeutic effect of cannulated compression screws and femoral neck dynamic cross screws in treatment for adult femoral neck fractures

目的在成人股骨颈骨折患者中,对比股骨颈动力交叉钉(FNS)和空心加压螺钉(CCS)的疗效,得出两者治疗效果的差别。方法分析研究2019年1月至2022年1月连云港市第一人民医院住院治疗的62例成人股骨颈骨折患者的临床数据。依据固定方式将患者分为CCS组(31例)和FNS组(31例)。比较两组手术期出血量、手术操作时长、股骨颈长度改变、手术后部分和完全下地负重时间、偏心距变化、术后不良反应发生率、术后1年髋关节功能Harris评分。结果FNS组术后部分及完全下地负重时间均优于CCS组[(2.4±0.2)周vs.(6.2±0.3)周、(6.6±0.2)周vs.(10.6±0.3)周](P<0.05);两组股骨颈短缩长度FNS组短于CCS组{[3.8(3.3,4.3)]mm vs.[3.8(3.6,6.3)]mm}(P<0.05);FNS组偏心距变化小于CCS组{[0.6(0.4,0.7)]cm vs.[0.9(0.8,1.5)]cm}(P<0.05);FNS组Harris评分高于CCS组{[93(92,93)]分vs.[86(84,90)]分}(P<0.05);FNS组术后不良反应发生率小于CCS组(3.2%vs.25.8%)(P<0.05)。两组手术期出血量、手术操作时长比较,差异无统计学意义(P>0.05)。结论FNS可减少偏心距变化和术后不良反应发生率,允许术后早期下地负重,并在股骨颈长度维护和髋关节功能恢复方面有所帮助,尤其在不稳定型股骨颈骨折中。

【Objective】To compare the efficacy of femoral neck dynamic cross screws and cannulated compression screws in adult patients with femoral neck fractures.【Methods】Clinical data of 62 hospitalized adult patients with femoral neck fractures from January 2019 to January 2022 were analyzed.The patients were divided into cannulated compression screw(CCS)group(31 cases)and femoral neck dynamic cross screw system(FNS)group(31 cases)according to fixation methods.Blood loss during operation,operation duration,femoral neck length change,time of partial and complete weight bearing after operation,offset change,incidence of postoperative adverse reactions,Harris score of hip function at 1 year after operation were compared between the two groups.【Results】FNS group was significantly better than CCS group in time of partial and complete weight bearing after operation(2.4±0.2 weeks vs.6.2±0.3 weeks,6.6±0.2 weeks vs.10.6±0.3 weeks)(P<0.05).The femoral neck shortening length in FNS group[3.8(3.3,4.3)mm]was shorter than that in CCS group[3.8(3.6,6.3)mm](P<0.05).The change of eccentricity in FNS group was 0.6(0.4,0.7)cm,which was significantly less than that in CCS group[0.9(0.8,1.5)cm](P<0.05).Harris score of 93(92,93)in FNS group was significantly higher than that of 86(84,90)in CCS group(P<0.05).The incidence of postoperative adverse reactions in FNS group was 3.2%(1/31),which was significantly lower than that in CCS group[25.8%(8/31)].There were no significant differences in blood loss during operation and operation duration between the two groups(P>0.05).【Conclusion】In this study,FNS reduced offset variation and postoperative adverse events,allowed early postoperative weight-bearing,and helped maintain femoral neck length and hip function,especially in unstable femoral neck fractures.