股骨颈动力交叉钉系统治疗中青年PauwelsⅡ型股骨颈骨折临床价值  

Clinical value of femoral neck dynamic cross nailing system for treatment of Pauwels typeⅡfemoral neck fracture in young and middle-aged adults

作　　者：葛双雷[1] 王雪飞[1] 胡国东[1] 龙安华 赵福龙[1] 张学东[1] GE Shuang-lei;WANG Xue-fei;HU Guo-dong;LONG An-hua;ZHAO Fu-long;ZHANG Xue-dong(Trauma Orthopedics,Beijing Luhe Hospital Affiliated to Capital Medical University,Beijing,101100,China)

机构地区：[1]首都医科大学附属潞河医院创伤骨科,北京101100

出　　处：《中国骨与关节杂志》2022年第4期255-260,共6页Chinese Journal of Bone and Joint

摘　　要：目的探讨股骨颈动力交叉钉系统(femoral neck system,FNS)治疗中青年PauwelsⅡ型股骨颈骨折的临床价值。方法回顾性分析2018年11月至2020年11月我科诊治且符合选择标准的79例中青年PauwelsⅡ型股骨颈骨折患者的临床资料,分为A组(35例,空心螺钉内固定治疗)和B组(44例,FNS内固定治疗)。对比A、B组患者手术操作时间、术中出血量、C型臂X线机透视次数以及骨折痊愈时间;分析骨折复位质量并测量患侧股骨颈短缩;评估髋关节Harris评分。结果术后A组2例骨折复位指数为(Ⅲ+Ⅳ),B组3例骨折复位指数为(Ⅲ+Ⅳ)。余患者术中复位指数为Ⅰ或Ⅱ。A、B组之间骨折复位指数差异无统计学意义(P>0.05);两组手术时间差异无统计学意义(P>0.05)。A组的术中出血量略少于B组,差异无统计学意义(P>0.05);B组术中的透视次数明显少于A组,差异有统计学意义(P<0.05)。A组4例术后3个月内空心螺钉倒出(断端无骨痂生长)、头钉切出,B组4例术后3个月头钉切出,余两组患者骨折均临床痊愈。两组患者的骨折痊愈时间差异无统计学意义(P>0.05)。A组3例股骨头坏死(8.57%),B组4例股骨头坏死(9.09%),差异无统计学意义(P>0.05)。于末次临床病例随访时,X线片检查结果显示A组中5例术后发生颈短缩,B组中2例术后发生颈短缩,A、B组内固定术后股骨颈短缩患者的骨折均为临床愈合,差异无统计学意义(P>0.05)。于末次随访时记录、分析髋关节功能评分,Harris评分差异无统计学意义(P>0.05)。结论与空心螺钉内固定治疗中青年PauwelsⅡ型股骨颈骨折相比,FNS在获得良好临床效果同时,可显著减少术中透视次数。Objective To investigate the clinical value of femoral neck dynamic cross nailing system(FNS)in the treatment of femoral neck fracture of Pauwels typeⅡin young and middle-aged adults.Methods Clinical data of 79 young and middle-aged patients with Pauwels typeⅡfemoral neck fracture who met the selection criteria and were treated in our department from November 2018 to November 2020 were retrospectively analyzed.They were divided into group A(35 cases,treated with hollow screw internal fixation)and group B(44 cases,treated with FNS internal fixation).The operative time,intraoperative blood loss,c-arm fluoroscopy frequency and fracture healing time of group A and B were compared.The reduction quality of the fracture was analyzed and the femoral neck shortening of the affected side was measured.Harris score of hip joint was assessed.Results The fracture reduction index was(Ⅲ+Ⅳ)in 2 patients in group A and(Ⅲ+Ⅳ)in 3 patients in group B.The remaining patients had an intraoperative reduction index ofⅠorⅡ.There were no significant differences in fracture reduction index between group A and group B(P>0.05).There were no significant differences in operation time between the two groups(P>0.05).The intraoperative blood loss in group A was slightly less than that in group B,and the differences were not statistically significant(P>0.05).The fluoroscopy frequency of group B was significantly lower than that of group A with statistical significance(P<0.05).Inverted hollow nail(no callus growth at the broken end)and head nail cut out were observed in 4 cases of group A within 3 months after operation;head nail cut out was seen in 4 cases of group B 3 months after operation;clinical union was achieved in other patients.There were no statistical differences in fracture healing time between the two groups(P>0.05).There were 3 cases of femoral head necrosis in group A(8.57%)and 4 cases in group B(9.09%),but no statistical differences were noted(P>0.05).At the last follow-up,X-ray examination results showed that 5 patie

关 键 词：股骨颈骨折 中年人 治疗结果 股骨颈动力交叉钉系统 

分 类 号：R683.4[医药卫生—骨科学]