股骨颈动力交叉钉系统动力棒偏移对早期临床结果的影响研究  

Influence of deviation of the bolt in femoral neck system on the short-term clinical outcomes

作　　者：金宇杰 周晓强 李志强 刘宇博 徐人杰[1] 沈军[1] 张向鑫[1] 虞宵 Jin Yujie;Zhou Xiaoqiang;Li Zhiqiang;Liu Yubo;Xu Renjie;Shen Jun(Department of Orthopaedics,Nanjing Medical University Gusu College,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou Municipal Hospital,Suzhou 215000,China)

机构地区：[1]南京医科大学姑苏学院,南京医科大学附属苏州医院,苏州市立医院骨科,苏州215000

出　　处：《中华创伤骨科杂志》2024年第6期473-480,共8页Chinese Journal of Orthopaedic Trauma

基　　金：江苏省科技厅重点研发项目(BE2021659);南京医科大学姑苏学院青年骨干科学研究培育专项(GSKY20220521);苏州市第十六批科技发展计划项目(SLJ2022014);苏州市第十二批科技发展计划项目(SLJ2021020)。

摘　　要：目的:探讨股骨颈动力交叉钉系统(FNS)治疗中青年移位型股骨颈骨折过程中其动力棒偏移对术后早期临床结果的影响。方法:回顾性分析2019年12月至2023年1月期间苏州市立医院骨科采用FNS固定治疗的114例中青年移位型股骨颈骨折患者资料。根据术后FNS动力棒末端相对于股骨头颈中心轴线的偏移程度(W)不同分为两组:中心组(W≤20%)63例,男27例,女36例;年龄(46.4±8.0)岁。偏移组(W>20%)51例,男20例,女31例;年龄(45.1±9.8)岁。比较两组患者的术后患肢负重时间、骨折愈合时间、尖顶距、末次随访时股骨颈短缩程度、髋关节Harris评分、欧洲五维健康量表(EQ-5D-5L)效用值、并发症发生率及翻修手术率等。结果:两组患者术前一般资料及骨折复位质量比较差异均无统计学意义( P>0.05),具有可比性。两组患者术后患肢部分负重时间比较差异无统计学意义( P>0.05)。中心组患者术后患肢完全负重时间[15.0(14.0,16.0)周]、骨折愈合时间[14.0(12.0,15.0)周]显著短于偏移组患者[16.0(15.0,19.0)、15.0(13.0,17.0)周],尖顶距[(21.4±3.4)mm]显著小于偏移组患者[(23.5±2.7)mm],末次随访时髋关节Harris评分[(90.6±6.1)分]、EQ-5D-5L效用值[0.9(0.8,0.9)]显著高于偏移组患者[(87.7±6.2)分、0.9(0.8,0.9)],中重度股骨颈短缩发生率[25.4%(16/63)]、股骨头缺血性坏死发生率[0(0/63)]、翻修手术率[0(0/63)]显著低于偏移组患者[66.7%(34/51)、7.8%(4/51)、9.8%(5/51)],差异均有统计学意义( P< 0.05)。 结论:FNS固定治疗中青年移位型股骨颈骨折时,将FNS动力棒尽可能靠近股骨头颈中心轴线置入可获得满意的临床疗效,并能降低翻修手术率。ObjectiveTo explore the influence of deviation of the bolt in femoral neck system(FNS)on the short-term outcomes in young and middle-aged patients with displaced femoral neck fracture.MethodsA retrospective analysis was conducted of the 114 young and middle-aged patients with displaced femoral neck fracture who had been treated with FNS at Department of Orthopaedics,Suzhou Municipal Hospital from December 2019 to January 2023.Based on the postoperative measurements of the deviation of the bolt tip to the central axis of the femoral head and neck(W),the patients were divided into a central group(W≤20%)and a deviation group(W>20%).In the central group of 63 cases,there were 27 males and 36 females with a mean age of(46.4±8.0)years.In the deviation group of 51 cases,there were 20 males and 31 females with a mean age of(45.1±9.8)years.The 2 groups were compared in terms of weight-bearing time,fracture healing time,tip-apex distance,degree of femoral neck shortening,Harris Hip Score and EuroQol five-dimensional questionnaire-5L(EQ-5D-5L)utility value at the last follow-up,as well as complications and revision surgeries.ResultsThere was no statistically significant difference in the preoperative general information,auxiliary reduction or quality of fracture reduction between the 2 groups,showing comparability between groups(P>0.05).There was no significant difference in the partial weight-bearing time between the 2 groups(P>0.05).In the central group,the full weight-bearing time[15.0(14.0,16.0)weeks]and fracture healing time[14.0(12.0,15.0)weeks]were significantly shorter than those in the deviation group[16.0(15.0,19.0)weeks;15.0(13.0,17.0)weeks],the tip-apex distance[(21.4±3.4)mm]was significantly shorter than that in the deviation group[(23.5±2.7)mm],the Harris Hip Score[(90.6±6.1)points]and EQ-5D-5L utility value[0.9(0.8,0.9)]at the last follow-up were significantly higher than those in the deviation group[(87.7±6.2)points;0.9(0.8,0.9)],and the incidences of moderate and severe femoral neck shortening[25.4%

关 键 词：股骨颈骨折 骨折固定术 内 骨钉 股骨颈动力交叉钉系统 

分 类 号：R687.3[医药卫生—骨科学]