倒三角空心螺钉内固定治疗青壮年股骨颈骨折的疗效  

Efficacy of inverted triangular cannulated screw internal fixation for femoral neck fracture in young and middle-aged patients

作　　者：孟飞 刘敏 袁明刚 崔林江 吕成昱[4] 张海宁[4] 李利昕 Meng Fei;Liu Min;Yuan Minggang;Cui Linjiang;Lyu Chengyu;Zhang Haining;Li Lixin(Department of Orthopedics,Qingdao Central Hospital,Rehabilitation University,Qingdao 266042,China;Department of Intensive Care Medicine,Qingdao Central Hospital of Rehabilitation University,Qingdao 266042,China;Department of Nuclear Medicine,Qingdao Central Hospital of Rehabilitation University,Qingdao 266042,China;Department of Joint Surgery,Affiliated Hospital of Qingdao University,Qingdao 266555,China)

机构地区：[1]康复大学青岛中心医院骨科,青岛266042 [2]康复大学青岛中心医院重症医学科,青岛266042 [3]康复大学青岛中心医院核医学科,青岛266042 [4]青岛大学附属医院关节外科,青岛266555

出　　处：《中华创伤杂志》2025年第1期58-64,共7页Chinese Journal of Trauma

基　　金：国家自然科学基金(81272056)。

摘　　要：目的比较倒三角与正三角空心螺钉内固定(CSIF)治疗青壮年股骨颈骨折(FNF)的效果。方法采用回顾性队列研究分析2020年1月至2022年1月康复大学青岛中心医院收治的52例FNF患者的临床资料,其中男18例,女34例;年龄28~60岁[(45.7±9.3)岁]。骨折Garden分型:Ⅰ型11例,Ⅱ型34例,Ⅲ型7例。骨折Pauwels分型:Ⅰ型33例,Ⅱ型13例,Ⅲ型6例。28例行倒三角CSIF治疗(倒三角组),24例行正三角CSIF治疗(正三角组)。术前和术后3个月行核医学三相骨显像及骨断层显像,比较2组骨折近端血供状况。比较2组术前和术后1 d、3个月及末次随访时Harris髋关节功能评分;术前及术后3个月股骨头后倾角;末次随访时骨折不愈合率、股骨头缺血坏死率。结果患者均获随访18~30个月[(24.2±5.6)个月]。术前2组骨折近端均存在广泛血供缺损;术后3个月,倒三角组骨折近端血供恢复优良率为92.9%(26/28),显著高于正三角组的70.8%(17/24)(P<0.05)。术前倒三角组与正三角组Harris髋关节功能评分分别为(44.1±4.1)分、(43.5±5.1)分(P>0.05);术后1 d、3个月及末次随访时,倒三角组Harris髋关节功能评分分别为(71.7±3.6)分、(87.0±3.6)分、(88.7±2.6)分,均显著高于正三角组的(65.0±5.4)分、(80.5±5.2)分、(82.6±4.0)分(P<0.05)。末次随访时,2组Harris髋关节功能评分与同组术后3个月差异均无统计学意义(P>0.05),但均显著高于同组术后1 d(P<0.05)。术前倒三角组和正三角组股骨头后倾角分别为(16.9±4.4)°、(16.8±5.0)°(P>0.05);术后3个月,倒三角组和正三角组股骨头后倾角分别为(8.9±1.9)°、(9.0±1.8)°(P>0.05)。术后3个月,2组股骨头后倾角均小于同组术前(P<0.05)。末次随访时,2组骨折不愈合率和股骨头缺血坏死率差异均无统计学意义(P>0.05)。结论与正三角CSIF比较,倒三角CSIF治疗青壮年FNF具有骨折近端血供与髋关节功能恢复更好的优势。Objective To compare the efficacy of inverted triangular and equilateral triangular cannulated screw internal fixation(CSIF)in the treatment of femoral neck fracture(FNF)in young and middle-aged patients.Methods A retrospective cohort study was conducted to analyze the clinical data of 52 patients with FNF admitted to Qingdao Central Hospital of Rehabilitation University from January 2020 to January 2022,including 18 males and 34 females,aged 28⁃60 years[(45.7±9.3)years].Based on the Garden classification,the fractures were classified as type I in 11 patients,type II in 34,and type III in 7.According to Pauwels classification,the fractures were classified as type I in 33 patients,type II in 13,and type III in 6.Among them,28 patients received inverted triangular CSIF(inverted triangle group)and 24 received equilateral triangular CSIF(equilateral triangle group).Before surgery and at 3 months after surgery,nuclear medicine three⁃phase bone scan and bone tomography imaging were performed to evaluate the proximal blood supply recovery in the fractured sites in the two groups.The Harris hip joint function scores before surgery,at 1 day,3 months after surgery,and at the last follow⁃up,the posterior tilt angles of the femoral head before surgery and at 3 months after surgery,and the fracture nonunion rate and ischemic necrosis rate of the femoral head at the last follow⁃up were compared between the two groups.Results All the patients were followed up for 18⁃30 months[(24.2±5.6)months].Before surgery,the fracture of both groups showed extensive blood supply defects at the proximal end.At 3 months after surgery,the excellent and good rate of the proximal blood supply recovery in the inverted triangle group was 92.9%(26/28),significantly higher than 70.8%(17/24)in the equilateral triangle group(P<0.05).The Harris hip joint function scores before surgery were(44.1±4.1)points and(43.5±5.1)points in the inverted triangle group and equilateral triangle group(P>0.05).At 1 day,3 months after surgery,and at the las

关 键 词：股骨颈骨折 内固定器 股骨头 全身成像 血供重建 

分 类 号：R683.4[医药卫生—骨科学]