两种内固定方式治疗青壮年PauwelsⅢ型股骨颈骨折近期临床疗效的对比  

Comparison of recent clinical efficacy of two internal fixation methods for the treatment of Pauwels typeⅢfemoral neck fractures in young adults

作　　者：刘虎 田宝方[2,3] 张娜 房好林 LIU Hu;TIAN Baofang;ZHANG Na;FANG Haolin(Clinical Medical College,Jining Medical University,Jining 272067,China;Department of Emergency Trauma Surgery,the First People's Hospital of Jining,Jining 272002,China;Trauma Institute of Jining Medical Research Academy,Jining 272004,China;Department of Emergency,Qufu Hospital of Traditional Chinese Medicine,Jining 273199,China)

机构地区：[1]济宁医学院临床医学院,272067 [2]济宁市第一人民医院急诊创伤外科,272002 [3]济宁市医学科学研究院创伤研究所,272004 [4]曲阜市中医院急诊科,273199

出　　处：《国际骨科学杂志》2023年第6期385-391,共7页International Journal of Orthopaedics

基　　金：山东省医药卫生科技发展项目(202204070583);2022年济宁市重点研发项目(2022YXNS122)。

摘　　要：目的比较空心钉附加内侧支撑钢板与股骨颈动力交叉钉系统(FNS)内固定治疗青壮年PauwelsⅢ型股骨颈骨折的近期临床疗效。方法纳入2019年1月至2021年12月济宁市第一人民医院收治的40例青壮年PauwelsⅢ型股骨颈骨折患者作为研究对象,其中20例患者采用3枚空心钉附加内侧支撑钢板内固定治疗(A组),20例患者采用FNS内固定治疗(B组)。两组患者随访时间至少1年,记录并比较两组手术情况、术后恢复质量、术后并发症、Harris髋关节功能评分(HHS评分)、巴塞尔指数(Barthel指数)、日常活动能力评定量表(ADL)评分情况。结果A组切口平均长度大于B组,平均手术时间长于B组,术中平均出血量大于B组,但A组术中透视次数少于B组,术中复位质量优良率高,两组差异均有统计学意义(P<0.05)。术后14 d内A组疼痛视觉模拟评分(VAS)大于B组(P<0.05),14 d后两组VAS评分无统计学差异(P>0.05);A组离床时间术后开始负重锻炼时间、骨折愈合时间均较B组短(P<0.05)。A组术后并发症仅有2例(骨折不愈合及股骨头坏死各1例),较B组术后并发症8例(其中骨折不愈合1例,股骨头坏死2例,感染2例,内固定失效3例)少(P<0.05)。术后6个月、12个月A组HHS评分、Barthel指数、ADL评分明显高于B组(P<0.05)。结论对于青壮年PauwelsⅢ型股骨颈骨折,相对于FNS内固定,空心钉附加内侧支撑钢板内固定尽管手术创伤偏大,但术中复位更满意,术后短期髋关节功能恢复更佳,术后股骨头坏死率及内固定失效率更低,可加快患者恢复进程,实现生活质量提升。Objective To compare the recent clinical efficacy of a hollow nail with medial support plate with the efficacy of the femoral neck system(FNS)using a dynamic cross nail in the treatment of Pauwels typeⅢfemoral neck fracture in young adults.Methods A total of 40 young and middle-aged patients with typeⅢfemoral neck fracture treated in Jining First People's Hospital between January 2019 and December 2021 were included as study subjects,of whom 20 patients were treated with three hollow nails plus a medial support plate for internal fixation(group A)and 20 others treated with FNS internal fixation(group B).Patients in both groups were followed up for at least 1 year,and the operation status,postoperative recovery quality,postoperative complications,Harris hip function score(HHS score),Barthel index,and ADL score of the two groups were recorded and compared.Results The mean incision length and operation time in group A was longer than that in group B,and the mean intraoperative blood loss was greater than that in group B;however,the intraoperative fluoroscopy times in group A were shorter than those in group B,and the intraoperative reduction quality was significantly higher(P<0.05).The visual analogue scale(VAS)score of group A was higher than that of group B within 14 days after surgery,but this difference in VAS score was not significant(P>0.05).The times to weight-bearing exercise and fracture healing in group A were shorter than those in group B(P<0.05).There were only two postoperative complications in group A(one case of fracture nonunion and one case of femoral head necrosis),fewer than the eight cases in group B(one case of fracture nonunion,two cases of femoral head necrosis,two cases of infection,and three cases of internal fixation failure)(P<0.05).The HHS score,Barthel index,and ADL score of group A were all significantly higher than those of group B at 6 and 12 months after operation(P<0.05).Conclusion For young adults with Pauwels typeⅢfemoral neck fracture,compared with FNS internal fixation,hol

关 键 词：股骨颈骨折 手术治疗 内侧支撑钢板 动力交叉钉系统 

分 类 号：R687.3[医药卫生—骨科学]