股骨颈系统与空心钉双平面垂直固定治疗中青年股骨颈骨折的临床效果分析  

Femoral neck system versus dual-plane vertical fixation with cannulated screws for femoral neck fractures in young and middle-aged adults:clinical outcome comparison

作　　者：李冲 李磊 李蒙 周咏辉 徐玮 徐磊 方诗元 Li Chong;Li Lei;Li Meng;Zhou Yonghui;Xu Wei;Xu Lei;Fang Shiyuan(Department of Orthopedics,Anhui Medical University Affiliated Anhui Provincial Hospital,Hefei 230001,China)

机构地区：[1]安徽医科大学附属省立医院骨科,合肥230001

出　　处：《创伤外科杂志》2025年第3期186-192,共7页Journal of Traumatic Surgery

摘　　要：目的比较股骨颈动力交叉钉系统(FNS)与4枚空心螺钉(4CS)双平面垂直固定方式治疗中青年PauwelsⅢ型股骨颈骨折患者的临床效果。方法回顾性分析2021年6月—2022年12月安徽医科大学附属省立医院骨科收治的中青年原发性PauwelsⅢ型股骨颈骨折患者65例。男性34例,女性31例;年龄18~63岁,平均44.3岁;致伤原因:道路交通伤32例,高处坠落伤33例。根据手术选择的内固定方式不同分为FNS组(35例)和4CS组(30例)。两组患者年龄、性别、受伤侧别、受伤至手术时间、基础疾病和致伤原因等方面比较差异均无统计学意义(P>0.05)。对两组患者的关键变量进行分析,包括人口统计学和临床变量、围术期指标、术后结局和并发症,以及术后1 d、6个月、12个月及末次随访时髋关节功能Harris评分和VAS等。结果患者随访12~36个月,均获骨性愈合。围术期指标方面,与FNS组相比,4CS组切口长度较短[(3.6±0.5)cm vs.(6.8±1.0)cm,P<0.001],透视次数较少[(61.1±5.0)次vs.(70.0±5.6)次,P<0.001]。4CS组开始负重时间晚于FNS组,但在完全负重时间[(11.7±2.0)周vs.(15.6±2.8)周]、骨折愈合时间[(15.1±1.9)周vs.(18.1±2.8)周]和股骨颈短缩[(2.5±0.7)mm vs.(4.3±1.1)mm]方面优势显著,差异有统计学意义(P均<0.001)。末次随访两组均未观察到股骨头坏死。在术后1 d、6、12个月以及末次随访时,4CS组的髋关节功能Harris评分显著高于FNS组(P<0.05)。整个随访期间,4CS组的VAS显著低于FNS组(P<0.05),表明4CS组在术后疼痛控制方面表现更佳。结论与FNS相比,采用4CS在治疗中青年股骨颈骨折方面临床疗效显著,具有透视次数少、切口长度短、股骨颈短缩长度减少及骨折愈合快等优点。Objective To evaluate and compare the clinical efficacy between femoral neck system(FNS)and four cannulated screws(4CS)dual-plane vertical fixation in treating Pauwels typeⅢfemoral neck fractures in young and middle-aged patients.Methods A retrospective analysis was conducted on 65 patients with primary Pauwels typeⅢfemoral neck fractures treated at our department from Jun.2021 to Dec.2022.The cohort included 34 males and 31 females,with an age range of 18 to 63 years(mean 44.3 years).The causes of injury were road traffic accidents in 32 cases and falls from height in 33.Based on the surgical fixation,patients were divided into two groups:the FNS group(35 cases)and the 4CS group(30 cases).No statistically significant difference was found between the two groups in terms of age,gender,injury location,time from injury to surgery,underlying diseases,or mechanism of injury(P>0.05).Key variables analyzed for both groups included demographic and clinical characteristics,perioperative indicators,postoperative outcomes and complications,as well as hip joint function assessed by the Harris hip score(HHS),and pain evaluated by VAS at 1 day,6 and 12 months after surgery and final follow-up.Results All patients were followed up for 12 to 36 months,with all achieving bone healing.In terms of perioperative indicators,the 4CS group had a significantly shorter incision length(cm,3.6±0.5 vs.6.8±1.0)and fewer fluoroscopy times(61.1±5.0 vs.70.0±5.6)than the FNS group(both P<0.001).Regarding postoperative outcomes and complications,although the 4CS group had a slower start of weight-bearing compared to the FNS group,it demonstrated significant advantages in full weight-bearing time(weeks,11.7±2.0 vs.15.6±2.8),fracture healing time(weeks,15.1±1.9 vs.18.1±2.8),and femoral neck shortening(mm,2.5±0.7 vs.4.3±1.1),all P<0.001.No avascular necrosis was observed in either group until the last follow-up.Throughout the entire follow-up period,the HHS for hip joint function in the 4CS group was significantly higher than that in t

关 键 词：股骨颈骨折 股骨颈系统 空心螺钉 双平面垂直固定 临床效果 中青年 

分 类 号：R687.3[医药卫生—骨科学]