双头加压螺钉与空心拉力螺钉治疗GardenⅠ、Ⅱ型股骨颈骨折的疗效对比  

A comparative study between double-threaded compression screws and cannulated lag screws for fixation of Garden typeⅠ/Ⅱfemoral neck fractures

作　　者：李岩[1] 龙江[1] 袁志[1] 

机构地区：[1]第四军医大学西京医院创伤骨科,西安710032

出　　处：《中华骨科杂志》2017年第17期1069-1074,共6页Chinese Journal of Orthopaedics

摘　　要：目的 比较运用双头加压螺钉与单头空心拉力螺钉治疗GardenⅠ、Ⅱ型股骨颈骨折的临床疗效。方法 回顾性分析2012年7月至2016年3月随访资料完整采用手术治疗的56例GardenⅠ、Ⅱ型股骨颈骨折患者资料。按照不同手术固定方式分为双头加压螺钉组（双头钉组）和空心拉力螺钉组（单头钉组）。双头钉组27例,男7例,女20例;年龄（55.5±10.0）岁;GardenⅠ型14例,GardenⅡ型13例;骨质疏松患者10例。单头钉组29例,男8例,女21例;年龄（57.2±9.5）岁;GardenⅠ型11例,GardenⅡ型18例;骨质疏松患者15例。比较两组患者的骨折愈合时间、骨不连发生率、股骨头缺血性坏死率、股骨颈短缩情况及髋关节Harris评分。结果 双头钉组平均随访（20.3±8.7）个月,单头钉组平均随访（24.5±7.9）个月。骨折愈合时间双头钉组平均（5.3±0.6）个月, 单头钉组平均（4.1±0.8）个月,两组比较差异有统计学意义（t=5.758,P=0.00）;随访过程中两组均有1例发生股骨头缺血性坏死;双头钉组3例（11.1%,3/27）发生骨不连,单头钉组1例（3.4%,1/29）,两组骨不连发生率无统计学差异;两组患者均出现股骨颈短缩,其中双头钉组在水平（5.8±2.9）mm及垂直（7.0±3.4）mm方向的短缩均低于单头钉组[（8.2±3.1） mm和（9.4±3.6） mm],两组比较差异有统计学意义（t=-2.94,P=0.005;t=-2.48,P=0.016）;术后髋关节Harris评分,双头钉组平均为（88.2±8.3）分,单头钉组平均（89.9±7.2）分,两组无差异。结论 与空心拉力螺钉相比,双头加压螺钉固定治疗GardenⅠ、Ⅱ型股骨颈骨折可减少股骨颈短缩,但不利于骨折愈合,且患者功能并没有明显优于空心拉力螺钉。Objective To compare the results between double-threaded compression screws and cannulated lag screws for Garden type I/II femoral neck fractures. Methods Data of 56 patients with Garden type I/II femoral neck fractures who were treated with internal fixation from July 2012 to March 2016 were retrospectively analyzed. According to different fixation, the patients were divided into two groups： double-threaded screws group （group A） including 27 cases （7 males and 20 females, with an average age of 55.5±10.0 years, 14 cases Garden type I and 13 cases Garden type II, the proportion of osteoporosis 10/27; And lag screws group （group B） including 29 cases （8 males and 21 females, with an average age of 57.2±9.5 years, 11 cases Garden type I and 18 cases Garden type II, the proportion of osteoporosis 15/29. The 2 groups were compared with respect to bony fusion time, nonunion, avascular necrosis of femoral head, shortening of femoral neck and Harris Hip Score. Results The average follow-up time was 20.3±8.7 m in Group A and 24.5±7.9 m in Group B. The average bony fusion time was 5.3±0.6 m in Group A and 4.1±0.8 m in Group B, and there was significant difference between the groups （t=5.758, P=0.00）. 1 avascular necrosis of femoral head was found in both groups. In group A, there were 3 cases of bone nonunion （11.1%, 3/27）. There were one bone nonunion （3.4%, 1/29） case in group B, with no statistically significant difference between groups. Shortening of femoral neck occurred in both groups, the average horizontal shortening was 5.8±2.9 mm and vertical shortening 7.0±3.4 mm in Group A, which were lower than group B （8.2±3.1 mm, 9.4±3.6 mm）, and the differences showed statistically significant（t=-2.94, P=0.005; t=-2.48, P=0.016）. In group A, the average Harris Hip score was 88.2±8.3, while that in group B was 89.9±7.2. There was no statistically significant difference between two groups. Conclusion It seems to us that in the treatment of Garden type I/II femoral neck fracture

关 键 词：股骨颈骨折 骨折固定术 内 骨螺丝 

分 类 号：R687.3[医药卫生—骨科学]