股骨颈系统与空心钉固定股骨颈骨折的比较  

Femoral neck system versus cannulated screws for fixation of femoral neck fractures

作　　者：罗仲伟[1] 何超 程飞[1] 龚广政 惠正广[1] 沈金虎[1] 杨六中[1] LUO Zhong-wei;HE Chao;CHENG Fei;GONG Guang-zheng;HUI Zheng-guang;SHEN Jin-hu;YANG Liu-zhong(Department of Orthopaedics,Xuzhou Hospital of Traditional Chinese Medicine,Nanjing University of Chinese Medicine,Xuzhou 221000,China)

机构地区：[1]南京中医药大学附属徐州市中医院骨伤科,江苏徐州221000

出　　处：《中国矫形外科杂志》2023年第16期1458-1463,共6页Orthopedic Journal of China

基　　金：徐州市科技创新项目(编号:KC22181)。

摘　　要：[目的]比较股骨颈系统(femoral neck system,FNS)与空心钉(cannulated screw,CS)固定治疗股骨颈骨折的临床疗效。[方法]回顾性分析2020年2月—2021年2月于本院行内固定手术治疗的50例股骨颈骨折患者的临床资料。依据术前医患沟通结果,25例采用FNS固定,另外25例采用CS固定。比较两组围手术期、随访及影像资料。[结果]两组患者均顺利完成手术,无严重并发症。FNS组的手术时间[(45.1±7.0) min vs (51.8±8.7) min,P<0.05]、术中透视次数[(8.8±1.8)次vs (15.5±2.4)次,P<0.05]、导针定位次数[(3.4±0.9)次vs (8.8±1.5)次,P<0.05]及下地行走时间[(4.0±1.2)周vs (6.2±1.1)周,P<0.05]均显著优于CS组,但是前者切口总长度[(4.5±0.5) cm vs (3.5±0.5) cm,P<0.05]和术中失血量[(84.6±21.1) ml vs (43.2±8.7) ml,P<0.05]均显著大于后者。FNS组恢复完全负重活动时间[(11.1±1.2)周vs (13.5±1.5)周,P<0.05]显著早于CS组。随时间推移两组Harris评分、髋伸-屈ROM、髋内旋-外旋ROM均显著增加;术后1、3个月及末次随访时FNS组Harris评分[(55.2±3.2) vs (46.8±2.8),P<0.05;(80.8±3.4) vs (78.4±1.9),P<0.05;(89.8±2.6) vs (87.6±2.6),P<0.05]均显著优于CS组,但是相应时间点两组间髋伸-屈ROM、髋内旋-外旋ROM的差异均无统计学意义(P>0.05)。影像方面,两组术后即刻及末次随访时,Garden对线指数较术前显著改善(P<0.05),与术前相比,两组术后即刻、术后3个月及末次随访时,颈干角及Tonnis髋退变分级无显著变化(P>0.05),相应时间点,两组间上述影像指标的差异均无统计学意义(P>0.05)。[结论]在股骨颈骨折治疗中,FNS具有手术时间短、稳定性强、髋关节功能恢复好等优点。[Objective]To compare the clinical efficacy of femoral neck system(FNS)versus cannulated screws(CS)for fixation of femoral neck fracture.[Methods]A retrospective study was performed on 50 patients who received internal fixation for femoral neck fractures in our hospital from February 2020 to February 2021.According to preoperative doctor-patient communication,25 patients had the fractures fixed by FNS,while the other 25 patients were by CS.The perioperative period,follow-up and imaging data of the two groups were compared.[Results]All patients in both groups were operated on successfully without serious complications.The FNS group proved significantly superior to the CS group in terms of operation time[(45.1±7.0)min vs(51.8±8.7)min,P<0.05],intraoperative fluoroscopy times[(8.8±1.8)vs(15.5±2.4),P<0.05],guide pin placement times[(3.4±0.9)vs(8.8±1.5),P<0.05]and postoperative walking time[(4.0±1.2)weeks vs(6.2±1.1)weeks,P<0.05],despite of the fact that the former was significantly greater than the latter in terms of total incision length[(4.5±0.5)cm vs(3.5±0.5)cm,P<0.05]and intraoperative blood loss[(84.6±21.1)ml vs(43.2±8.7)ml,P<0.05].The FNS group resumed full weight-bearing activity significantly earlier than the CS group[(11.1±1.2)weeks vs(13.5±1.5)weeks,P<0.05].The Harris score,hip extension-flexion ROM and hip internal-rotation rotation ROM significantly increased over time in both groups(P<0.05).The FNS group was significantly better than the CS group in Harris score at 1 month,3 months postoperatively and at the latest follow-up[(55.2±3.2)vs(46.8±2.8),P<0.05;(80.8±3.4)vs(78.4±1.9),P<0.05;(89.8±2.6)vs(87.6±2.6),P<0.05],although there were no significant differences in extension-flexion ROM and internal rotation-external ROM between the two groups at any corresponding time points(P>0.05).Regarding to imaging,Garden alignment index significantly improved in both groups immediately after surgery and at the last follow-up compared with that before operation(P<0.05).However,the neck-shaft angle

关 键 词：股骨颈骨折 骨折复位 内固定 股骨颈系统 空心钉 

分 类 号：R683.42[医药卫生—骨科学]