横向松质骨拉力螺钉与普通空心螺钉治疗股骨颈骨折的疗效比较  

Comparison of transverse cancellous bone lag screw and ordinary hollow screw in the treatment of femoral neck fracture

作　　者：王斌 陈剑楼 郁国荣 郭平 WANG Bin;CHEN Jian-lou;YU Guo-rong;GUO Ping(The Second People’s Hospital of Zhangjiagang,Zhangjiagang,Jiangsu,215600,China)

机构地区：[1]张家港市第二人民医院骨科,江苏215600

出　　处：《中国骨与关节杂志》2022年第4期249-254,共6页Chinese Journal of Bone and Joint

基　　金：江苏省卫生计生委2017年医学科研课题指导性课题(Z201721)。

摘　　要：目的比较横向松质骨拉力螺钉(transverse cancellous lag screw,TCLS)和普通空心螺钉(ordinary cannulated screw,OCS)对股骨颈骨折的治疗效果。方法回顾性分析2016年1月至2018年12月,我院收治的85例PauwelsⅢ型股骨颈骨折患者,其中男46例,女39例;年龄19~62岁,平均55.2岁。分为TCLS固定组(TCLS组,n=42)和OCS固定组(OCS组,n=43)。收集围术期临床指标(包括手术时间、术中失血量、临床抽血化验指标和住院时间);术后各种量表进行评估,包括疼痛视觉模拟评分(visual analogue scale,VAS)和Harris髋关节评分(Harris hip score,HHS),记录并发症(骨不连、股骨头坏死、股骨颈短缩和固定失败),并进行统计学比较。结果TCLS组的平均随访时间为15.4个月,OCS组的平均随访时间为14.7个月。两组之间手术时间、术中失血量以及治疗前后的血红蛋白和住院时间差异均无统计学意义(P>0.05)。两组VAS评分以及包括骨不连和股骨头坏死在内的并发症发生率差异也无统计学意义。但是在末次随访中,TCLS组的HHS评分优于OCS组,并且与OCS组相比,TCLS组的股骨颈短缩率显著降低,差异有统计学意义(P<0.05)。结论TCLS技术治疗股骨颈骨折可显著改善髋关节功能,并降低术后股骨颈短缩率,并为股骨颈骨折的治疗提供了新颖的见解。Objective To compare the therapeutic effects of transverse cancellous lag screw(TCLS)and ordinary cannulated screw(OCS)on femoral neck fractures.Methods A retrospective analysis of 85 patients with Pauwels TypeⅢfemoral neck fracture in our hospital from January 2016 to December 2018 was conducted.There were 46 males and 39 females with an average age of 55.2 years(range:19-62 years).All patients were divided into two groups:42 cases in the CLS fixed group(TCLS group)and 43 cases in the OCS fixed group(OCS group).Perioperative clinical indicators including operation time,intraoperative blood loss,clinical blood test results and hospital stay were collected.Postoperative evaluations including visual analog scale(VAS),Harris hip score(HHS)and complications(nonunion,femoral head necrosis,femoral neck shortening and fixation failure)were analyzed for comparison.Results The average follow-up time of the TCLS group was 15.4 months,and the OCS group14.7 months.There were no significant differences in operation time,intraoperative blood loss,hemoglobin before and after treatment,and hospital stay between the two groups(P>0.05).Similarly,there were no significant differences in VAS and the incidence of complications including nonunion and femoral head necrosis between the two groups.However,HHS of the TCLS group was better than that of the OCS group at the last follow-up.Compared with the OCS group,femoral neck shortening rate of the TCLS group was significantly lower(P<0.05).Conclusions The TCLS technique can significantly improve hip joint function and reduce postoperative femoral neck shortening rate in the treatment of femoral neck fractures.

关 键 词：股骨颈骨折 股骨头坏死 骨钉 

分 类 号：R683.4[医药卫生—骨科学]