四枚空心钉菱形四壁支撑内固定股骨颈骨折  

Four cannulated screws for four-wall supporting internal fixation of femoral neck fracture

作　　者：孙彦豹[1] 金宝城[1] 王静[1] 白冰[1] 赵胜军[1] 侯艳[1] SUN Yan-bao;JIN Bao-cheng;WANG Jing;BAI Bing;ZHAO Sheng-jun;HOU Yan(The Second Department of Orthopedics,Chengde Central Hospi-tal,Chengde067000,China)

机构地区：[1]河北省承德市中心医院骨二科,河北承德067000

出　　处：《中国矫形外科杂志》2020年第20期1857-1861,共5页Orthopedic Journal of China

基　　金：河北省医学科学研究重点课题计划项目(编号:20160304)。

摘　　要：[目的]通过与常规三枚空心内固定比较,评价应用四枚空心钉菱形四壁支撑内固定治疗股骨颈骨折的临床效果。[方法]回顾性分析2016年1月~2018年12月行空心钉固定69例股骨颈骨折患者的临床资料。其中,33例采用四枚空心钉菱形四壁支撑内固定手术治疗(四钉组),36例采用常规三枚空心钉内固定治疗(三钉组)。比较两组患者围手术期、随访和影像资料。[结果]两组患者手术时间、术中出血量、切口长度、透视次数和住院时间的差异均无统计学意义(P>0.05)。所有患者随访12~36个月,平均(24.67±6.70)个月。四钉组临床股骨头坏死发生率显著低于三钉组(P>0.05)。四钉组完全负重行走时间、末次随访时Harris评分和末次随访时髋关节屈伸ROM均显著优于三钉组(P<0.05)。影像方面,两组骨折复位质量的差异无统计学意义(P>0.05),术后6个月和末次随访时,四钉组颈干角显著大于三钉组(P<0.05),而四钉组股骨颈短缩显著小于三钉组(P<0.05)。[结论]四枚空心钉菱形四壁支撑内固定治疗股骨颈骨折可获得更好的功能恢复,减少股骨头坏死与股骨颈短缩的发生。[Objective]To evaluate the clinical outcomes of four cannulated screws for four-wall supporting internal fixation of femoral neck fractures by comparison with conventional three cannulated screws.[Methods]A retrospective study was conducted on 69 patients who underwent cannulated screw fixation for femoral neck fractures from January 2016 to December 2018.Of them,33 patients received four-wall supporting fixation with four cannulated screws after closed reduction,while the remaining 36 patients underwent conventional fixation with three cannulated screws.The perioperative,follow-up and radiographic documents were compared between the two groups.[Results]There were no statistically significant differences in operation time,intraoperative blood loss,incision length,intraoperative fluoroscopic frequency and hospital stay between the two groups(P>0.05).The patients were followed up for 12~36 months with a mean of(24.67±6.70)months.The four-screw group had significantly lower clinical occurrence of femoral head necrosis than the three-screw group to the latest follow-up(P<0.05).In addition,the four-screw group proved significantly superior to the three-screw group regarding to the time to return fullweight bearing activity,Harris score and ROM at the latest follow-up(P<0.05).In term of radiographic assessment,the fourscrew group had significantly greater femoral neck-shaft angle,whereas significantly less femoral neck shortening than the three-screw group at 3 months postoperatively and the latest follow-up(P<0.05),nevertheless no a statistical difference in quality of fracture reduction was found between them immediately after operation(P>0.05).[Conclusion]The four cannulated screws for four-wall supporting internal fixation of femoral neck fractures do improve functional recovery and reduce the chance of femoral head necrosis and femoral neck shortening.

关 键 词：股骨颈骨折 闭合复位 空心钉 内固定 

分 类 号：R683.42[医药卫生—骨科学]