动力髋螺钉+防旋螺钉与3枚空心钉固定治疗伴后侧壁碎裂的股骨颈骨折的疗效比较  

Comparison of dynamic hip screw plus anti-rotation screw versus three cannulated compression screws in treatment of femoral neck fractures with comminuted posterior wall

作　　者：郭先超 张凯瑞[1] 刘昱辰 周叙有 廖峻城 张晟[1] Guo Xianchao;Zhang Kairui;Liu Yuchen;Zhou Xuyou;Liao Juncheng;Zhang Sheng(Division of Orthopaedics and Traumatology,Department of Orthopaedics,Nanfang Hospital,Southern Medi-cal University,Guangzhou 510515,China;Department of Orthopaedics,Shenzhen Hospital,University of Chinese Academy of Sciences,Shenzhen 518107,China)

机构地区：[1]南方医科大学南方医院骨科-创伤骨科,广州510515 [2]中国科学院大学深圳医院(光明)骨科,深圳518107

出　　处：《中华创伤骨科杂志》2022年第6期538-542,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的比较动力髋螺钉(DHS)+防旋螺钉与3枚空心钉(CCS)固定治疗伴后侧壁碎裂的股骨颈骨折的疗效。方法回顾性分析2017年2月至2019年12月期间中国科学院大学深圳医院(光明)骨科收治的109例合并后侧壁碎裂的股骨颈骨折患者资料。根据治疗方式不同分为两组:CCS组58例,男42例,女16例;年龄为48.5(40.0,55.3)岁,采用3枚CCS固定治疗。DHS组51例,男31例,女20例;年龄为47.0(38.0,53.0)岁;采用DHS+防旋螺钉固定治疗。比较两组患者的手术切口长度、手术时间、术中出血量、患肢负重时间、疼痛视觉模拟评分(VAS)、髋关节Harris评分及并发症发生率等。结果两组患者术前一般资料及随访时间比较差异均无统计学意义(P>0.05),具有可比性。CCS组患者的手术切口长度[3.0(2.9,4.5)cm]、手术时间[90.0(73.8,125.0)min]显著短于DHS组患者[10.0(9.0,12.0)cm、135.0(110.0,165.0)min],术中出血量[40.0(10.0,100.0)mL]显著少于DHS组患者[200.0(150.0,300.0)mL],患肢部分、完全负重时间[12.0(12.0,13.0)、24.0(21.0,25.0)周]显著长于DHS组患者[11.0(10.0,12.0)、19.0(18.0,20.0)周],围手术期疼痛VAS评分[2.0(2.0,3.0)分]显著低于DHS组患者[5.0(4.0,6.0)分],但随访期间并发症发生率[56.9%(33/58)]显著高于DHS组患者[33.3%(17/51)],差异均有统计学意义(P<0.05)。DHS组与CCS组患者术后1年髋关节Harris评分优良率[94.1%(48/51)、91.4%(53/58)]比较差异均无统计学意义(P>0.05)。结论虽然DHS+防旋螺钉与3枚CCS内固定治疗伴后侧壁碎裂的股骨颈骨折的近期疗效均良好,但是后期随访并发症发生率仍较高。与后者比较,前者可缩短患肢负重时间、降低并发症发生率,但创伤较大。Objective To compare the efficacy of 2 fixation modes[dynamic hip screw(DHS)plus anti-rotation screw versus 3 cannulated compression screws(CCS)]in the treatment of femoral neck fractures complicated with comminuted posterior wall.Methods The data were analyzed retrospectively of the 109 patients who had been treated for femoral neck fractures complicated with comminuted posterior wall at Department of Orthopaedics,Shenzhen Hospital,University of Chinese Academy of Sciences from February 2017 to December 2019.They were divided into 2 groups according to 2 fixation modes.There were 42 males and 16 females with an age of 48.5(40.0,55.3)years in CCS group of 58 cases subjected to fixation with 3 CCSs;there were 31 males and 20 females with an age of 47.0(38.0,53.0)years in DHS group of 51 cases subjected to fixation with DHS plus anti-rotation screw.The length of incision,operation time,intraoperative bleeding,weight-bearing time for the affected limb,visual analog scale(VAS),hip Harris score,and incidence of postoperative complications were compared between the 2 groups.Results The comparison of preoperative general data between the 2 groups was not statistically significant,showing comparability between groups(P>0.05).In the CCS group,the incision length[3.0(2.9,4.5)cm]and operation time[90.0(73.8,125.0)min]were significantly shorter than those in the DHS group[10.0(9.0,12.0)cm and 135.0(110.0,165.0)min],the intraoperative bleeding[40.0(10.0,100.0)mL]was significantly less than that in the DHS group[200.0(150.0,300.0)mL],the partial and complete weight-bearing durations of the affected limb[12.0(12.0,13.0)weeks and 24.0(21.0,25.0)weeks]were significantly longer than those in the DHS group[11.0(10.0,12.0)weeks and 19.0(18.0,20.0)weeks],and the perioperative VAS pain score[2.0(2.0,3.0)points]was significantly lower than that in the DHS group[5.0(4.0,6.0)points],but the incidence of follow-up complications[56.9%(33/58)]was significantly higher than that in the DHS group[33.3%(17/51)](all P<0.05).There was no signific

关 键 词：股骨颈骨折 骨折固定术 内 骨钉 后侧壁碎裂 

分 类 号：R687.3[医药卫生—骨科学]