股骨颈动力交叉钉系统和倒三角空心钉治疗PauwelsⅢ型股骨颈骨折疗效比较  

Comparison of femoral neck system and inverted triangle cannulated screws fixations in treatment of Pauwels typleⅢfemoral neck fractures

作　　者：杨家赵 周雪锋 李黎[1] 徐磊[1] 朱万博 徐玮 夏睿 王叙进 王刚[2] 华兴一[2] 许新忠[3] 方诗元 YANG Jiazhao;ZHOU Xuefeng;LI Li;XU Lei;ZHU Wanbo;XU Wei;XIA Rui;WANG Xujin;WANG Gang;HUA Xingyi;XU Xinzhong;FANG Shiyuan(Department of Orthopedics and Traumatology,the First Affiliated Hospital of USTC(Anhui Provincial Hospital),Hefei Anhui,230001,P.R.China;Department of Orthopedics and Traumatology,the First Affiliated Hospital of Anhui Medical University,Hefei Anhui,230022,P.R.China;Department of Orthopedics and Traumatology,the Second Affiliated Hospital of Anhui Medical University,Hefei Anhui,230601,P.R.China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)创伤骨科,合肥230001 [2]安徽医科大学第一附属医院创伤骨科,合肥230022 [3]安徽医科大学第二附属医院创伤骨科,合肥230601

出　　处：《中国修复重建外科杂志》2021年第9期1111-1118,共8页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：安徽省立医院医疗领先技术项目(2020LXJS);安徽省科技攻关计划项目(1401045022)。

摘　　要：目的比较股骨颈动力交叉钉系统(femoral neck system,FNS)和倒三角空心钉(inverted triangle cannulated screws,ITCS)治疗PauwelsⅢ型股骨颈骨折的临床疗效。方法回顾分析2019年5月—2020年11月收治的59例PauwelsⅢ型股骨颈骨折患者临床资料,根据内固定方式不同分为FNS组(28例)和ITCS组(31例)。两组患者性别、年龄、侧别、身体质量指数、致伤原因、吸烟史、酗酒史、Pauwels角、Garden分型、国际内固定研究协会/美国骨创伤协会(AO/OTA)分型及受伤至手术时间等一般资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、切口长度、术中出血量、辅助复位(经皮克氏针撬拨复位或切开复位)、住院时间和早期并发症,并采用Garden指数和Haidukewych评分评价骨折复位情况;术后定期随访,比较两组骨折愈合时间、有无大腿外侧激惹症状、术后部分或完全负重开始时间、股骨颈短缩长度和程度、颈干角变化(术后即刻与末次随访时颈干角的差值)、股骨头坏死及翻修手术等,采用Harris评分评价髋关节功能。结果FNS组手术时间短于ITCS组、切口长度大于ITCS组(P<0.05);两组术中出血量、辅助复位情况、Garden指数、Haidukewych评分及住院时间比较差异均无统计学意义(P>0.05)。术后患者手术切口均Ⅰ期愈合;FNS组术后早期发生下肢深静脉血栓形成2例,ITCS组发生肺部感染1例、下肢深静脉血栓形成1例,两组术后早期并发症发生率(7.1%vs.6.5%)比较差异无统计学意义(P=1.000)。两组患者均获随访,随访时间3~14个月,两组随访时间比较差异无统计学意义(t=–0.553,P=0.582)。FNS组骨折愈合时间快于ITCS组,髋关节Harris评分高于ITCS组,术后部分负重开始时间早于ITCS组,差异均有统计学意义(P<0.05);但两组完全负重开始时间差异无统计学意义(Z=–1.298,P=0.194)。FNS组患者均无大腿外侧激惹症状,ITCS组有10例出现大腿外�Objective To compare the effectiveness of the femoral neck system(FNS)and inverted triangle cannulated screws(ITCS)for the treatment of Pauwels typeⅢfemoral neck fractures.Methods The clinical data of 59 patients with Pauwels typeⅢfemoral neck fractures treated between May 2019 and November 2020 were retrospectively analysed.The patients were divided into FNS group(28 cases)and ITCS group(31 cases)according to the different internal fixation.There was no significant difference in gender,age,affected side,body mass index,cause of injury,smoking history,alcohol abuse history,Pauwels angle,Garden classification,AO/Orthopaedic Trauma Association(AO/OTA)classification,and time from injury to operation between the two groups(P>0.05).The operation time,incision length,intraoperative blood loss,extra assisted reduction procedures(Kirschner wire prying reduction or open reduction),hospitalization stay,and early complications were recorded and compared between the two groups.Garden index and Haidukewych score were used to evaluate fracture reduction.Fracture healing time,lateral thigh irritation,time of partial or total weight-bearing postoperatively,shortening length and degree of femoral neck,change of caput-collumdiaphysis(CCD)angle(the difference of CCD angle between immediate after operation and last follow-up),incidence of osteonecrosis of femoral head and revision surgery were recorded and compared between the two groups.Hip joint function were evaluated by Harris score.Results The operation time of FNS group was significantly shorter than ITCS group,and the incision length was significantly longer than ITCS group(P<0.05).There was no significant difference in intraoperative blood loss,assisted reduction,Garden index,Haidukewych score,and hospitalization stay between the two groups(P>0.05).All the incisions healed by first intention.There were 2 deep vein thrombosis in the FNS group and 1 pulmonary infection and 1 deep vein thrombosis in the ITCS group.No significant difference was found in the incidence of earl

关 键 词：股骨颈骨折 股骨颈动力交叉钉系统 倒三角空心钉 内固定 复位 

分 类 号：R687.3[医药卫生—骨科学]