股骨颈系统与空心钉固定青壮年股骨颈骨折的比较
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1.西安医学院;2.西安市红会医院;3.西安第五医院

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陕西省重点研发基金项目(2019SF-192);陕西省自然科学基础研究计划(2022JM-546)


Comparison of effectiveness of femoral neck system and cannulated screws in treatment of femoral neck fracture in young and middle-aged patients
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Affiliation:

1.Xi’an Medical University;2.Xi’an Honghui Hospital;3.Xi'4.'5.an No.5 Hospital

Fund Project:

Key research and developed projects of Shaanxi Province(2019SF-192);Natural Science basic Research Program of Shaanxi Province(2022JM-546)

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    摘要:

    摘要:[目的] 比较股骨颈系统(femoral neck system,FNS)与空心钉(cannulated screws, CS)治疗青壮年股骨颈骨折的临床疗效。[方法] 回顾性分析自2019年6月至2021年6月期间西安交通大学医学院附属红会医院诊治的137例青壮年股骨颈骨折患者的临床资料,其中64例采用FNS固定, 73例采用CS固定。比较两组围手术期、随访和影像资料。[结果] FNS组手术时间、透视次数、部分负重时间均优于CS组(P<0.05);但CS组切口长度较FNS组短(P<0.05);随术后时间推移,两组VAS评分均显著减小(P<0.05);FNS组在术后3d、7d、30d的VAS评分显著小于CS组(P<0.05);两组术前及术后1d的VAS评分、术中失血量、辅助复位情况、切口愈合情况及住院时间的比较差异均无统计学意义(P>0.05)。随访6~21个月,FNS组平均(13.81±3.15)个月,CS组平均(14.90±4.87)个月。至末次随访时,CS组21例(28.8%),FNS组1例(1.6%)出现患侧大腿外侧异物摩擦感或疼痛。CS组2例(2.7%)因股骨头坏死行全髋关节置换。随术后时间推移,两组髋关节Harris评分、髋屈-伸及内-外旋ROM均显著增加(P<0.05)。相应时间点,FNS组的Harris评分、髋屈-伸及内-外旋ROM均显著优于CS组(P<0.05)。影像方面,FNS组骨折愈合时间显著小于CS组,并且末次随访中FNS组股骨颈短缩、颈干角及内固定切出明显优于CS组(P<0.05)。两组术后即刻的Garden对线指数、股骨颈短缩、颈干角、骨不连及股骨头坏死比较无统计学差异(P>0.05)。 [结论] FNS固定牢靠,在缩短了下地时间和骨折愈合时间的同时,能较好的维持患者术后的颈干角及股骨颈长度,并能有效减少内固定切出及患侧大腿外侧激惹。利于患者术后髋关节功能的恢复,临床疗效较好。

    Abstract:

    Abstract: [Objective] Comparison of the effectiveness of femoral neck system (FNS) and cannulated screw (CS) in the treatment of femoral neck fractures in young and middle-aged patients. [Methods] A retrospective analysis was conducted of the 137 young and middle-aged patients who had been surgically treated for femoral neck fracture at Honghui Hospital from June 2019 to June 2021.The patients were divided into CS group (73 cases) and FNS group (64 cases). Perioperative conditions, follow-up consequences and imaging data were compared between the two groups. [Results] In the FNS group, operation time, fluoroscopy frequency, postoperative partial weight-bearing time was significantly superior than those in the CS group, and the incision length was significantly longer than CS group (P<0.05); VAS scores in both groups decreased significantly with postoperative time, and VAS scores in the FNS group were significantly lower than those in the CS group at 3, 7, and 30 days postoperatively (P<0.05). There was no significant difference in intraoperative blood loss, auxiliary reduction, wound healing and hospital stay between the 2 groups(P>0.05). The follow-up period lasted for 6 to 21 months. The FNS group lateral thigh irritation (1 ,1.6%) significantly lower than that in the CS group(21cases, 28.8%). Two patients(2.7%)in the CS group underwent total hip arthroplasty due to femoral head necrosis. Harris score and hip mobility increased significantly in both groups with postoperative time, and The FNS group was significantly superior than those in the CCS group at the same time point (P<0.05). With respect to radiographic evaluation, the FNS group fracture healing time was significantly less than that in the CS group. In the last follow-up, femoral neck shortening, neck-shaft angle and internal fixation withdrawal in the FNS group were better than those in the CS group (P<0.05). There were no significant differences in Garden index, neck shortening and neck-shaft angle between the 2 groups in the immediate postoperative period(P>0.05).[Conclusion] FNS can firmly fix the fracture and reduce lateral thigh irritation caused by internal fixation withdrawal. While shortening the postoperative partial weight-bearing time and fracture healing time, it can better maintain the postoperative neck-shaft angle and femoral neck length, which is conducive to the recovery of postoperative hip joint function.

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  • 收稿日期:2022-01-24
  • 最后修改日期:2022-05-01
  • 录用日期:2022-07-19
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