空心加压螺钉与动力髋螺钉螺旋刀片治疗股骨颈骨折的临床疗效及生物力学分析  

Cannulated compression screw versus dynamic hip screw-blade in the treatment of femoral neck fractures

作　　者：骆东[1] 孙大辉[1] 姚霁航[1] 杨凯[1] 张晓猛[1] 鞠维娜[1] 祁宝昌[1] 

机构地区：[1]吉林大学第一医院创伤骨科,长春130021

出　　处：《中华创伤骨科杂志》2016年第8期647-654,共8页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（81500911）

摘　　要：目的比较空心加压螺钉（CCS）与动力髋螺钉螺旋刀片（DHS-B）治疗股骨颈骨折的临床疗效及生物力学性能。方法回顾性分析2010年2月至2014年2月期间采用CCS或DHS．B治疗的102例股骨颈骨折患者资料，男54例，女48例；年龄为15～86岁；骨折类型：头下型30例，经颈型51例，基底型21例。根据内固定方式不同分为2组：CCS组60例，DHS．B组42例。比较2组患者的疗效。选取12具成人尸体股骨标本，制成股骨颈骨折模型，随机分为2组（n=6）：A组采用3枚CCS固定，B组采用DHS．B固定，进行轴向载荷试验、水平扭转试验及轴向加压破坏试验。结果CCS组患者的手术时间【（59．4±20．2）min]和切口长度[（4．1±0．6）cm]显著短于DHS．B组患者[（88．6±22．9）min、（12．1±1．2）cm】，术中出血量[（25．9±9．9）mL]显著少于DHS．B组患者[（156．7±107．1）mL】，末次随访时髋关节Harris评分[（87．2±9．2）分]显著低于DHS．B组患者[（91．94-9．8）分】，差异均有统计学意义（P〈0．05）。两组患者的住院时间、部分负重时间及术后并发症发生率等比较差异均无统计学意义（P〉0．05）。载荷为500N时，无论是股骨内侧还是外侧，A组的应变值均显著大于B组，差异有统计学意义（P〈0．05）。而A组与B组的股骨头下沉位移和扭角为60时的扭矩比较差异均无统计学意义（P〉0．05）。A组最大载荷【（2135±120）N】显著小于B组[（29864-98）N】，差异有统计学意义（P〈0．05）。结论DHS—B固定股骨颈骨折更符合股骨的生物力学特性，具有良好的防旋和抗压能力，患者髋关节功能恢复良好，较CCS具有明显优势。compression screw Objective To compare the curative effect and biomechanical performance of cannulated （CCS） and dynamic hip screw-blade （DHS-B） in the treatment of patients with femoral neck fracture. Methods Between February 2010 and February 2014, 102 patients with femoral neck fracture were treated with CCS or DHS-B at our department. They were 54 males and 48 females, aged from 15 to 86 years. There were 30 subcapital fractures, 51 transcervical ones and 21 base ones. CCS was used in 60 patients and DHS-B in 42. In-hospital data were collected retrospectively to compare the curative effects in 2 groups. Furthermore, femoral neck fracture models were established using 12 adult cadaveric femoral specimens. The 12 models were randomized into 2 equal groups （ n = 6）. Group A was subjected to fixation by 3 CCSs and group B to fixation by DHS-B. The 2 groups were compared in terms of axial loading test, rotation test and destructive axial loading test. Results The operation time （59.4 ± 20. 2 rain）, incision size （4. 1 ± 0. 6 cm） and intraoperative blood loss （25.9 ± 9.9 mL） in the CCS group were significantly less than those in the DHS-B group （88.6±22.9 rain, 12. 1 ±1.2 cm and 156.7±107. 1 mL） （P 〈0.05） . The Harris hip score for the DHS-B group （91.9 ± 9.8） was significantly higher than that for the CCS group （87.2 ± 9.2） （ P 〈 0.05） . There were no significant differences between the 2 groups in hospital stay, partial weight-bearing time, or postoperative complications （ P 〉 0.05）. At 500 N vertical loading, the stress values at both medial and lateral sides of the femur in group A were significantly smaller than those in group B （ P 〈 0. 05） . There were no significant differences between groups A and B in the average sinking displacement of femoral head or the torque at a torsion angle of 6± （ P 〉 0. 05）. The maximum load in group A （2, 135 ± 120 N） was significantly smaller than that in group B （2, 986 ± 98 N） （ P 〈 0.

关 键 词：股骨颈骨折 骨折固定术 内 骨钉 生物力学 

分 类 号：R687.3[医药卫生—骨科学]