股骨颈动力交叉螺钉系统与螺纹空心钉治疗垂直不稳定股骨颈骨折短期随访
摘要点击次数: 203   全文下载次数: 102   投稿时间:2022-12-16    
作者Author单位AddressE-Mail
王强 WANG Qiang 山西医科大学第二医院创伤骨科, 山西 太原 030001 Department of Trauma and Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China  
吕欣 LYU Xin 山西医科大学第二医院创伤骨科, 山西 太原 030001 Department of Trauma and Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China 13623634222@126.com 
李兴业 LI Xing-ye 山西医科大学第二医院创伤骨科, 山西 太原 030001 Department of Trauma and Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China  
刘晋元 LIU Jin-yuan 山西医科大学第二医院创伤骨科, 山西 太原 030001 Department of Trauma and Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China  
期刊信息:《中国骨伤》2024年,第37卷,第5期,第458-463页
DOI:10.12200/j.issn.1003-0034.20220547
基金项目:国家自然科学基金(编号:82172439)
中文摘要:

目的:分析比较股骨颈动力交叉螺钉系统(femoral neck dynamic cross screw system,FNS)和螺纹空心钉(cannulated screws,CS)治疗垂直不稳定股骨颈骨折临床效果。

方法:回顾分析2020年7月至2021年8月收治的40例垂直不稳定股骨颈骨折患者的临床数据和短期随访结果,根据不同的内固定治疗方法分为股骨颈动力交叉螺钉系统FNS组20例和螺纹空心钉CS组20例。FNS组中,男11例,女9例,年龄58.5(50.3,62.5)岁;CS组中,男9例,女11例,年龄52.0(40.5,58.0)岁。观察比较两组手术时间、手术刀口长度、手术中失血量、治疗费用。术后利用X线影像资料评价术后骨折愈合状况和手术内固定状况,并测量患侧股骨颈短缩状况。比较两组术后患侧大腿激惹症发生情况、术后部分负重以及完全负重时间、术后股骨头早期坏死、再次手术翻修情况以及Harris评分。

结果:FNS组获随访18.0(15.0,19.0)个月,CS组随访17.0(15.0,18.8)个月。两组手术时间、手术切口长度、手术中失血量比较,差异均无统计学意义(P>0.05)。FNS组的诊疗费用高于CS组(P<0.001)。FNS组术后无患侧大腿激惹征,而CS组6例存在大腿外侧不适或大腿外激惹征(P<0.05)。CS组术后平均部分负重活动时间和完全负重活动时间均长于FNS组(P<0.05)。末次随访时,CS组术后患侧股骨颈短缩长度大于FNS组(P<0.05)。两组均未发生术后股骨头早期坏死及再次手术翻修。两组术后12个月Harris评分比较,差异无统计学意义(P>0.05)。

结论:FNS治疗垂直不稳定股骨颈骨折可明显降低大腿外侧激惹征的发生率,并有效降低垂直不稳定股骨颈骨折术后短缩率,可提供较稳定的防旋力与抗切割力,使患者可以相对较早下地,有利于患者术后患侧髋关节功能恢复,是对于垂直不稳定股骨颈骨折手术治疗的一种全新选择,但由于治疗费用偏高,临床中因结合实际情况,选用恰当的手术治疗方式。
【关键词】股骨颈骨折  股骨颈动力交叉钉系统  空心钉  内固定
 
Short term follow-up of femoral neck dynamic cross screw system and threaded cannulated screw in the treatment of vertically unstable femoral neck fractures
ABSTRACT  

Objective To analyze and compare the clinical effects of femoral neck dynamic cross screw system (FNS) and cannulated screws(CS) in the treatment of vertically unstable femoral neck fractures.

Methods The clinical data and short-term follow-up results of 40 patients with vertically unstable femoral neck fractures admitted from July 2020 to August 2021 were retrospectively analyzed. According to different internal fixation methods,40 patients were divided into two groups,20 cases in FNS group included 11 males and 9 females with a median of 58.5(50.3,62.5) years old,and 20 in CS group included 9 males and 11 females with a median of 52.0(40.5,58.0) years old. The operation time,knife edge length,blood loss and treatment cost of two gruops were observed and compared. The postoperative fracture healing and internal fixation were evaluated with X-ray imaging data,and the femoral neck shortening of the affected side was measured. The incidence of thigh irritation,the time of partial weight bearing and full weight bearing,early necrosis of femoral head,reoperation revision and Harris scores were compared between two groups.

Results FNS group was followed up for 18.0(15.0,19.0) months,CS group for 17.0(15.0,18.8) months. There was no significant difference in operation time,incision length and blood loss between two groups(P>0.05). The cost of diagnosis and treatment in FNS group was higher than that in CS group(P<0.001). In FNS group,there was no irritation sign of the affected side thigh,while in CS group,there were 6 cases with discomfort or irritation sign of the lateral thigh(P<0.05). The average time of partial weight bearing activity in CS group was later than that in FNS group(P<0.05); However,there was no significant difference in the activity time of complete weight bearing between two groups(P=0.011>0.05). At the last follow-up,the shortened length of the affected femoral neck in CS group was greater than that in FNS group(P<0.05). There was no early necrosis of femoral head and reoperation in both groups. There was no significant difference in Harris score between two groups 12 months after operation(P>0.05).

Conclusion FNS treatment of vertically unstable femoral neck fractures can significantly reduce the incidence of lateral thigh irritation sign,and effectively reduce the postoperative shortening rate of vertically unstable femoral neck fractures,which can provide a relatively stable anti rotation force and anti cutting force,so that patients can go to the ground relatively early,which is conducive to the recovery of the affected hip joint function after surgery. It is a new option for the surgical treatment of vertically unstable femoral neck fractures. However,due to the high cost of treatment,In clinical practice,appropriate surgical treatment is selected according to the actual situation.
KEY WORDS  Femoral neck fracture  Femoral neck dynamic cross screw system  Cannulated screw  Internal fixation
 
引用本文,请按以下格式著录参考文献:
中文格式:王强,吕欣,李兴业,刘晋元.股骨颈动力交叉螺钉系统与螺纹空心钉治疗垂直不稳定股骨颈骨折短期随访[J].中国骨伤,2024,37(5):458~463
英文格式:WANG Qiang,LYU Xin,LI Xing-ye,LIU Jin-yuan.Short term follow-up of femoral neck dynamic cross screw system and threaded cannulated screw in the treatment of vertically unstable femoral neck fractures[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(5):458~463
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