空心螺钉内固定联合同种异体腓骨棒植骨治疗中青年股骨颈骨折的疗效  

Efficacy of internal fixation using cannulated screw combined with fibular allograft in the treatment of femoral neck fracture in young and middle‑aged patients

作　　者：王沛源 李子平 张志昂 焦振清[1] 赵阔 金霖[1,2] 侯志勇 Wang Peiyuan;Li Ziping;Zhang Zhiang;Jiao Zhenqing;Zhao Kuo;Jin Lin;Hou Zhiyong(Trauma Emergency Center,Hebei Medical University Third Hospital,Shijiazhuang 050051,China;Hebei Orthopedic Clinical Research Center,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院创伤急救中心,石家庄050051 [2]河北省骨科研究所,石家庄050051

出　　处：《中华创伤杂志》2024年第9期801-808,共8页Chinese Journal of Trauma

摘　　要：目的比较空心螺钉内固定联合同种异体腓骨棒植骨与单纯空心螺钉内固定治疗中青年股骨颈骨折的疗效。方法采用回顾性队列研究分析河北医科大学第三医院2020年1月至2022年12月收治的75例中青年股骨颈骨骨折患者的临床资料,其中男44例,女31例;年龄34~56岁[(46.1±12.7)岁]。骨折Garden分型:Ⅱ型26例,Ⅲ型35例,Ⅳ型14例;Pauwels分型:Ⅰ型9例,Ⅱ型31例,Ⅲ型35例。49例行单纯3枚空心螺钉内固定治疗(空心螺钉组),26例3枚行空心螺钉内固定联合同种异体腓骨棒平行植骨治疗(空心螺钉联合植骨组)。比较两组手术时间、术中出血量、住院时间及骨折复位质量;术后4、8个月及末次随访时股骨颈短缩分级、扶拐行走患者数、Barthel指数及Harris髋关节功能评分;末次随访时并发症发生率等。结果患者均获随访16~37个月[(23.2±4.5)个月]。空心螺钉联合植骨组手术时间为(86.3±16.1)min,长于空心螺钉组的(76.9±20.8)min(P<0.05)。空心螺钉联合植骨组术中出血量为100.0(50.0,200.0)ml,多于空心螺钉组的50.0(50.0,100.0)ml(P<0.01)。两组住院时间、骨折复位质量差异均无统计学意义(P>0.05)。术后4个月,空心螺钉联合植骨组股骨颈短缩分级[1级24例(92.3%),2级2例(7.7%),3级0例(0.0%)]优于空心螺钉组[1级18例(36.7%),2级28例(57.1%),3级3例(6.2%)](P<0.01)。术后8个月,空心螺钉联合植骨组股骨颈短缩分级[1级22例(84.6%),2级3例(11.5%),3级1例(3.8%)]优于空心螺钉组[1级13例(26.5%),2级27例(55.1%),3级9例(18.4%)](P<0.01)。末次随访时,空心螺钉联合植骨组股骨颈短缩分级[1级19例(73.0%),2级5例(19.2%),3级2例(7.6%)]优于空心螺钉组[1级8例(16.3%),2级31例(63.2%),3级10例(20.4%)](P<0.01)。术后4、8个月及末次随访时,空心螺钉联合植骨组扶拐行走患者数分别为12例(46.2%)、8例(30.8%)、5例(19.2%),空心螺钉组分别为38例(77.6%)、27例(55.1%)、20例(40.8%),除末次随访时两组差Objective To compare the efficacy of internal fixation using cannulated screw combined with fibular allograft and internal fixation using cannulated screw alone in the treatment of femoral neck fracture in young and middle⁃aged patients.Methods A retrospective cohort study was conducted to analyze the clinical data of 75 young and middle⁃aged patients with femoral neck fracture admitted to the Third Hospital of Hebei Medical University from January 2020 to December 2022,including 44 males and 31 females,aged 34⁃56 years[(46.1±12.7)years].According to Garden classification,26 patients were classified as type II,35 type III and 14 type IV.According to the Pauwels classification,9 patients were classified as type I,31 type II and 35 type III.Forty⁃nine patients were treated with internal fixation using three cannulated screws alone(cannulated screw group)and 26 with internal fixation using three cannulated screws combined with double⁃barrel fibular allograft(cannulated screw combined with bone grafting group).The operation time,intraoperative blood loss,length of hospital stay,and quality of fracture reduction were compared between the two groups.At 4,8 months after operation and at the last follow⁃up,grading of femoral neck shortening,number of patients walking with crutches,Barthel index,and Harris hip function score were evaluated.The incidence of complications was measured at the last follow⁃up.Results All the patients were followed up for 16⁃37 months[(23.2±4.5)months].The operation time of the cannulated screw combined with bone grafting group was(86.3±16.1)minutes,longer than(76.9±20.8)minutes of the cannulated screw group(P<0.05).The intraoperative blood loss was 100.0(50.0,200.0)ml in the cannulated screw combined with bone grafting group,more than 50.0(50.0,100.0)ml in the cannulated screw group(P<0.01).There were no significant differences in the length of hospital stay or the quality of fracture reduction between the two groups(P>0.05).At 4 months after operation,grading of the femora

关 键 词：股骨颈骨折 骨折固定术 内 成年人 骨螺丝 

分 类 号：R687.3[医药卫生—骨科学]