4枚空心钉菱形固定与动力髋螺钉加防旋钉治疗PauwelsⅢ型股骨颈骨折的比较  

Four cannulated screws in a diamond position versus dynamic hip screw combined with antirotation screw for the treatment of Pauwels typeⅢfemoral neck fractures

作　　者：王静[1] 孙彦豹[2] 金宝城[2] 付莹[2] 侯艳[2] Wang Jing;Sun Yanbao;Jin Baocheng;Fu Ying;Hou Yan(Department of Geriatrics,Chengde Central Hospital,Chengde,Hebei 067000,China;Department of Orthopedics 2,Chengde Central Hospital,Chengde,Hebei 067000,China)

机构地区：[1]承德市中心医院老年科,河北承德067000 [2]承德市中心医院骨二科,河北承德067000

出　　处：《创伤外科杂志》2022年第2期128-132,共5页Journal of Traumatic Surgery

基　　金：河北省医学科学研究重点课题计划(20160304)。

摘　　要：目的比较4枚空心钉菱形固定与动力髋螺钉(DHS)加防旋钉治疗PauwelsⅢ型股骨颈骨折的临床效果。方法回顾性分析2015年10月—2019年10月承德市中心医院收治PauwelsⅢ型股骨颈骨折患者62例,男性34例,女性28例;年龄21~65岁,平均50.1岁。按照内固定方法不同分为4钉组(29例)和DHS组(33例),4钉组采用闭合复位4枚空心钉菱形内固定,DHS组采用闭合复位DHS加防旋钉内固定。比较两组患者一般资料、手术时间、出血量等围术期情况及随访情况。结果患者获14~35个月随访,平均22.8个月,随访率100%。4钉组手术时间、出血量、切口长度、透视次数、住院时间均优于DHS组(54.3±10.1)min vs.(68.5±14.3)min、(61.5±8.3)mL vs.(97.7±15.3)mL、(5.1±1.2)cm vs.(9.7±1.4)cm、(14.8±1.3)次vs.(16.0±2.1)次、(10.7±1.9)d vs.(12.4±2.5)d,P<0.05。两组患者术后完全负重时间、末次随访时髋关节Harris评分、股骨头坏死、骨折不愈合及股骨颈短缩发生率比较差异均无统计学意义(P>0.05)。结论4枚空心钉菱形固定与DHS加防旋钉均能有效治疗PauwelsⅢ型股骨颈骨折,4枚空心钉有创伤小、出血少、住院时间短等优点,值得临床推广。Objective To compare the clinical effect of four cannulated screws in a diamond position and dynamic hip screw combined with antirotation screw for internal fixation of Pauwels typeⅢfemoral neck fractures.Methods A retrospective analysis was performed on 62 patients with femur neck fracture of Pauwels typeⅢtreated in Chengde Central Hospital from Oct.2015 to Oct.2019,including 34 males and 28 females.The age ranged from 21 to 65 years,with an average of 50.1 years.According to different internal fixation methods,the patients were divided into four-screw group(29 cases)and DHS group(33 cases).The four-screw group was treated with closed reduction and fixation with four cannulated screws in a diamond position,and the DHS group was treated with closed reduction and DHS combined with antirotation screw internal fixation.The general information,operation related and follow-up results of the two groups were compared.Results Patients were followed up for 14-35 months,with an average of 22.8 months,and the follow-up rate was 100%.The operation time,blood loss,incision length,fluoroscopy times and hospital stay of the four-screw group were better than those of the DHS group[(54.3±10.1)minutes vs.(68.5±14.3)minutes,(61.5±8.3)mL vs.(97.7±15.3)mL,(5.1±1.2)cm vs.(9.7±1.4)cm,(14.8±1.3)times vs.(16.0±2.1)times,(10.7±1.9)days vs.(12.4±2.5)days],respectively,with statistical significance(all P<0.05).There was no significant difference in the postoperative time to full weight bearing,the Harris score of hip joint at the last follow-up,the incidence of femoral head necrosis,fracture nonunion or femoral neck shortening rate between the two groups(P>0.05).Conclusion Four cannulated screws in a diamond position and dynamic hip screw combined with antirotation screw are both effective for treatment of Pauwels typeⅢfemoral neck fractures.The application of four cannulated screws in the treatment of femoral neck fracture has the advantages of less trauma,less bleeding and shorter hospitalization time,which is worthy of cl

关 键 词：股骨颈骨折 空心钉 动力髋螺钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]