股骨颈系统与空心拉力螺钉治疗股骨颈骨折近期临床疗效比较  

Comparison of the short-term clinical efficacy of femoral neck system and cannulated screw in the treatment of femoral neck fracture

作　　者：高培栗 罗刚[1] 倪卫东[1] Gao Peili;Luo Gang;Ni Weidong(Department of Orthopaedics,The First Affiliated Hospital of Chongqing Medical University)

机构地区：[1]重庆医科大学附属第一医院骨科,重庆400016

出　　处：《重庆医科大学学报》2022年第4期427-432,共6页Journal of Chongqing Medical University

摘　　要：目的:探讨股骨颈系统(femoral neck system,FNS)治疗股骨颈骨折的近期临床疗效。方法:采用回顾性病例对照研究分析2019年1月至2020年12月收治的45例股骨颈骨折患者临床资料,其中男性23例,女性22例,年龄28~68岁,平均年龄(52.3±11.2)岁。根据Pauwels分型,Ⅰ型6例,Ⅱ型23例,Ⅲ型16例。24例采用空心拉力螺钉固定设为A组;21例采用FNS固定设为B组。比较2组患者手术时间、术中出血量、复位质量、完全负重时间、骨折愈合时间、股骨头坏死、骨折不愈合、股骨颈短缩、内固定物退钉等情况以及末次随访患髋功能评分。结果:患者均获随访6~29个月,A组手术时间为(65.2±21.5)min,B组为(58.4±14.5)min(P>0.05)。A组术中出血量为(35.6±51.2)m L,B组出血量为(72.1±62.1)mL(P<0.05)。根据Haidukewych等提出的复位标准,A组复位质量优良20例,一般3例,差1例,优良率83.33%;B组优良19例,一般2例,差0例,优良率90.48%(P>0.05)。A组完全负重时间为(2.9±1.3)个月,B组为(3.1±1.5)个月(P>0.05)。A组骨折愈合时间为(4.4±1.4)个月,B组为(4.5±1.5)个月(P>0.05)。A组股骨头坏死2例,骨折不愈合4例,股骨颈短缩7例;B组股骨头坏死1例,骨折不愈合3例,股骨颈短缩6例(P>0.05)。A组退钉4例(17.67%),B组无退钉情况(P=0.05)。A组患者末次随访Harris评分(91.2±6.9)分;B组(92.0±7.5)分(P>0.05)。在PauwelsⅢ型患者中,A组患者末次随访Harris评分(89.7±4.8)分;B组(93.4±6.3)分(P>0.05),A组骨不连及股骨头坏死的总体发生率为33.33%,B组无骨不连及坏死发生(P>0.05)。结论:运用FNS治疗股骨颈骨折可以取得与空心拉力螺钉治疗相当的临床疗效,FNS可成为治疗股骨颈骨折的新选择。Objective:To investigate the short-term clinical effect of femoral neck system(FNS)on femoral neck fracture.Methods:A retrospective case-control study was performed to analyze the clinical data of 45 patients with femoral neck fracture admitted to the hospital from January 2019 to December 2020,including 23 males and 22 females,aged 28 to 68 years old[(52.3±11.2)years old in average].According to the Pauwels classification,6 cases were typeⅠ,23 typeⅡand 16 typeⅢ.Twenty-four cases were fixed with cannulated screws(group A),and 21 patients were fixed with FNS(group B).The operative time,intraoperative blood loss,reduction quality,time of weight-bearing,time of fracture healing,necrosis of femoral head,nonunion of fracture,shortening of femoral neck,nail removal of internal fixator and hip function score of the last follow-up were compared between the two groups.Results:All patients were followed up for 6-29 months,while the operative time of group A was(65.2±21.5)min and(58.4±14.5)min in group B(P>0.05),and the surgical blood loss of group A[(35.6±51.2)mL]was less than that of group B[(72.1±62.1)mL](P<0.05).According to the reduction standard proposed by Haidukewych et al.,20 patients in group A had good reduction quality,3 were average and 1was poor,with an excellent and good rate of 83.33%;19 patients in group B had good reduction quality,2 were average and 0 was poor,with an excellent and good rate of 90.48%(P>0.05).The weight-bearing time of group A was(2.9±1.3)months,and group B was(3.1±1.5)months(P>0.05).The fracture union time in group A was(4.4±1.4)months,and that in group B was(4.5±1.5)months(P>0.05).In group A,there were 2 cases of femoral head necrosis,4 cases of fracture nonunion and 7 cases of femoral neck shortening.In group B,there was 1 case of femoral head necrosis,3 cases of fracture nonunion,and 6 cases of femoral neck shortening(P>0.05).In group A,4 cases(17.67%)had screw withdrawal and there was no case of screw withdrawal in group B(P=0.05).The Harris scores of group A in the la

关 键 词：股骨颈骨折 空心拉力螺钉 股骨颈系统 内固定 

分 类 号：R683.4[医药卫生—骨科学]