股骨颈动力交叉钉系统与空心加压螺钉治疗中青年股骨颈骨折的疗效比较  

Comparison of effectiveness of femoral neck system and cannulate compression screw in treatment of femoral neck fracture in young and middle-aged patients

作　　者：严才平 王星宽 向超 蒋科[1] 李毓灵 陈骞[1] 邓长弓 陈路[1] YAN Caiping;WANG Xingkuan;XIANG Chao;JIANG Ke;LI Yuling;CHEN Qian;DENG Changgong;CHEN Lu(Department of Orthopedics,Affiliated Hospital of North Sichuan Medical College,Nanchong Sichuan,637000,P.R.China)

机构地区：[1]川北医学院附属医院骨科,四川南充637000

出　　处：《中国修复重建外科杂志》2021年第10期1286-1292,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：四川省医学会课题(2019HR19);四川省医学会创新科研项目(Q19069);四川省科技厅项目(2021YJ0467);南充市2019年市校合作项目(2019SHXZ0120);川北医学院附属医院科研项目(2021ZK001)。

摘　　要：目的比较股骨颈动力交叉钉系统(femoral neck system,FNS)与传统3枚空心加压螺钉(cannulate compression screw,CCS)治疗中青年股骨颈骨折患者的临床效果。方法回顾分析2018年1月—2020年9月收治且符合选择标准的82例中青年股骨颈骨折患者临床资料,根据手术方式不同分为FNS组(24例)和CCS组(58例)。两组患者性别、年龄、身高、体质量、致伤原因、合并症、骨折部位、骨折分型(Garden分型及Pauwels分型)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、术中出血量、并发症发生情况(骨不连、股骨头坏死、股骨颈短缩等)、术后2 d疼痛视觉模拟评分(VAS)、骨折临床愈合时间、术后髋关节Harris评分。结果两组患者均顺利完成手术,FNS组患者手术时间及术后2 d VAS评分均显著低于CCS组(P<0.05);两组术中出血量比较差异无统计学意义(t=0.263,P=0.796)。两组患者均获随访,CCS组随访时间6~18个月,平均13.6个月;FNS组随访时间3~12个月,平均7.3个月。两组均未发生内固定物松动并发症,CCS组发生股骨头坏死2例、骨不连1例、股骨颈短缩13例,FNS组仅发生2例股骨颈短缩,两组并发症发生率(27.6%vs. 8.3%)比较差异有统计学意义(χ^(2)=36.670,P=0.015)。CCS组3例因骨不连、股骨头坏死二期行人工髋关节置换术,余55例骨折均达临床愈合;FNS组中6例患者因随访时间不足6个月未纳入统计,余18例骨折均达临床愈合;两组骨折愈合时间比较差异有统计学意义(t=4.481,P=0.000)。FNS组术后髋关节Harris评分差值显著高于CCS组,两组术后9个月Harris评分均显著高于术后6个月,差异均有统计学意义(P<0.05)。结论 FNS能加速中青年患者股骨颈骨折的愈合,使患者可以尽早开始功能锻炼,从而降低了相关并发症发生率。Objective To compare the effectiveness of femoral neck system(FNS) and cannulate compression screw(CCS) in the treatment of femoral neck fractures in young and middle-aged patients. Methods The clinical data of82 young and middle-aged patients with femoral neck fracture treated between January 2018 and September 2020 were retrospectively analyzed. They were divided into FNS group(24 cases) and CCS group(58 cases) according to different surgical methods. There was no significant difference between the two groups(P>0.05) in general data such as gender, age,height, body mass, cause of injury, complications, fracture location, and fracture classification(Garden classification and Pauwells classification). The operation time, intraoperative blood loss, complications(nonunion, osteonecrosis of the femoral head, shortening of femoral neck, etc.), visual analogue scale(VAS) score at 2 days after operation, clinical healing time of fracture, and Harris score of hip joint after operation were recorded and compared between the two groups.Results The operation time and VAS score at 2 days after operation in FNS group were significantly lower than those in CCS group(P<0.05);there was no significant difference in intraoperative blood loss between the two groups(t=0.263, P=0.796).The patients in CCS group were followed up 6-18 months, with an average of 13.6 months;and the follow-up time in FNS group was 3-12 months, with an average of 7.3 months. There was no complication of internal fixator loosening in both groups. There were 2 cases of osteonecrosis of the femoral head, 1 case of bone nonunion, and 13 cases of femoral neck shortening in CCS group and only 2 cases of femoral neck shortening in FNS group. The difference in the incidence of complications between the two groups(27.6% vs. 8.3%) was significant(χ^(2)=36.670, P=0.015). In CCS group, 3 cases underwent secondary artificial hip arthroplasty due to bone nonunion and osteonecrosis of the femoral head, and the remaining 55 cases achieved clinical healing;in FNS group,

关 键 词：股骨颈动力交叉钉系统 空心加压螺钉 股骨颈骨折 内固定 

分 类 号：R687.3[医药卫生—骨科学]