断端皮质粉碎对青壮年股骨颈骨折股骨颈动力交叉钉系统固定术后疗效的影响研究  

Effects of cortical comminution following femoral neck fracture on fixation with femoral neck system in young adults

作　　者：吾米提·塔西 马信龙[1] 韩哲[1] 纪能能 孙翔[1] 韩超[1] 董强[1] Wumiti Taxi;Ma Xinlong;Han Zhe;Ji Nengneng;Sun Xiang;Han Chao;Dong Qiang(Department of Hip Orthopaedic Trauma,Tianjin Hospital,Tianjin 300211,China;Tianjin University of Traditional Chinese Medicine,Tianjin 301600,China)

机构地区：[1]天津医院创伤髋关节科,300211 [2]天津中医药大学,301600

出　　处：《中华创伤骨科杂志》2021年第9期775-781,共7页Chinese Journal of Orthopaedic Trauma

基　　金：天津市卫生健康科技项目(RC20199)。

摘　　要：目的探讨断端皮质粉碎对股骨颈动力交叉钉系统(FNS)固定治疗股骨颈骨折患者术后疗效的影响。方法回顾性分析2020年1月至12月期间天津医院创伤髋关节科采用FNS固定治疗的86例股骨颈骨折患者资料。根据股骨颈断端皮质是否粉碎,将患者分为两组:皮质粉碎组41例,男16例,女25例;年龄中位数为53.0(40.5,57.0)岁;股骨颈断端皮质粉碎。无皮质粉碎组45例,男21例,女24例;年龄中位数为55.0(44.5,62.5)岁;股骨颈断端皮质完整。对患者进行为期6个月的短期随访,记录并比较两组患者的术后并发症,以及术后6个月髋关节Harris评分、Barthel指数和疼痛视觉模拟评分(VAS)等。结果两组患者除了骨折分型之外,其他术前一般资料及复位方式等比较差异均无统计学意义(P>0.05),具有可比性。皮质粉碎组患者的骨不连、股骨颈短缩发生率[17.1%(7/41)、29.3%(12/41)]显著高于无皮质粉碎组患者[0%(0/45)、11.1%(5/45)],术后6个月髋关节Harris评分、Barthel指数[82.0(72.5,91.5)分、100.0(90.0,100.0)]显著低于无皮质粉碎组患者[94.0(88.0,98.0)分、100.0(100.0,100.0)],疼痛VAS评分[1.5(0,4.5)分]显著高于无皮质粉碎组患者[0(0,1.0)分],差异均有统计学意义(P<0.05)。而两组患者的股骨头坏死和内固定失效发生率比较差异均无统计学意义(P>0.05)。结论伴有断端皮质粉碎可能是股骨颈骨折FNS固定术后发生并发症的重要影响因素,其严重影响患者术后髋关节功能及生活质量的恢复。Objective To investigate the effects of cortical comminution on therapeutic outcomes and postoperative complications in young patients with femoral neck fracture after fixation with femoral neck system(FNS).Methods A retrospective study was conducted of the 86 patients with femoral neck fracture who had been treated by FNS fixation from January 2020 to December 2020 at Department of Hip Orthopaedic Trauma,Tianjin Hospital.Of them,41 had cortical comminution at the fracture ends of the femoral neck.They were 16 males and 25 females with a mean age of 53.0(40.5,57.0)years.The other 45 patients had intact cortical bone at the fracture ends of the femoral neck.They were 21 males and 24 females with a mean age of 55.0(44.5,62.5)years.The 2 groups were compared in terms of incidence of postoperative complications,Harris hip score,Barthel index and visual analogue scale(VAS)pain score after 6-month follow-up.Results There were no statistically significant differences between the 2 groups in baseline data or reduction mode except for fracture classification,showing comparability between groups(P>0.05).In the cortical comminution group,the incidences of nonunion[17.1%(7/41)]and femoral neck shortening[29.3%(12/41)]were significantly higher than those in the cortical intact group[0%(0/45)and 11.1%(5/45)],the Harris hip score and Barthel index[82.0(72.5,91.5)points and 100.0(90.0,100.0)]at 6 months postoperatively were significantly lower than those in the cortical intact group[94.0(88.0,98.0)points and 100.0(100.0,100.0)],the VAS pain score[1.5(0,4.5)points]was significantly higher than that in the cortical intact group[0(0,1.0)points](all P<0.05).However,there was no significant difference between the 2 groups in osteonecrosis of the femoral head or internal fixation failure(P>0.05).Conclusions Cortical comminution following femoral neck fracture is a major risk factor for post-operative complications after FNS fixation,because it may seriously affect the recovery of hip function and quality of life in young patients.

关 键 词：股骨颈骨折 骨折固定术 内 骨钉 术后并发症 断端皮质粉碎 

分 类 号：R687.3[医药卫生—骨科学]