两种股骨颈固定方案治疗股骨颈骨折的临床疗效比较_吴超.pdf

Hainan Med J,Jul.2023,Vol.34,No.13海南医学2023年7月第34卷第13期两种股骨颈固定方案治疗股骨颈骨折的临床疗效比较吴超1，王争刚1，周百刚2陕西省核工业二一五医院创伤骨科1、关节外科2，陕西咸阳712000【摘要】目的观察闭合复位下股骨颈动力交叉钉系统(FNS)与空心螺钉(CCS)固定治疗股骨颈骨折的疗效，并探讨其对患者围术期指标和并发症的影响。方法选取2021年1月至2022年1月于陕西省核工业二一五医院骨科就诊的108例股骨颈骨折患者为研究对象，采用双色球随机法分为FNS组和CCS组各54例。FNS组患者给予闭合复位下FNS固定，CCS组给予闭合复位下CCS固定。比较两组患者的手术情况(手术时间、术中出血量、术中透视次数)、术后恢复情况(下地负重时间、住院时间、骨折愈合时间)和术后第12个月时的股骨颈指标(股骨颈短缩长度、颈干角变化)、生活质量健康状况调查简表(SF-36)，同时比较两组患者术后第6个月、12个月时的髋关节功能髋关节功能评分表(Harris)和术后6个月内的并发症发生情况。结果两组患者术中出血量、住院时间比较差异均无统计学意义(P0.05)；FSN组患者手术时间、术中透视次数、下地负重时间、骨折愈合时间分别为(79.216.38)min、(9.522.32)次、(12.423.21)周、(16.194.17)周，明显短于CCS组的(83.166.52)min、(11.273.25)次、(14.643.35)周、(18.234.39)周，差异均有统计学意义(P0.05)；术后12个月，FNS组患者股骨颈短缩长度、颈干角变化分别为(2.751.05)mm、(3.501.03)，明显低于CCS组的(4.181.12)mm、(4.291.09)，差异均有统计学意义(P0.05)；术后12个月，两组患者Harris评分明显高于术后6个月，差异均有统计学意义(P0.05)；术后6个月内，FSN组患者的并发症总发生率为25.9%，略低于CCS组的38.9%，但差异无统计学意义(P0.05)。结论闭合复位下FNS和CCS治疗股骨颈骨折均可获得较好的临床治疗效果，但FNS具有手术时间短、术中出血量少、术后恢复快及对患者股骨颈影响较小等优势。【关键词】股骨颈骨折；股骨颈动力交叉钉系统；空心螺钉固定；围术期指标；并发症【中图分类号】R683.42【文献标识码】A【文章编号】10036350（2023）13187105Comparison on clinical efficacy of two femoral neck fixation regimens in the treatment of femoral neck fractures.WU Chao1,WANG Zheng-gang1,ZHOU Bai-gang2.Department of Trauma Orthopaedics1,Department of Joint Surgery2,No.215 Hospital of Shaanxi Nuclear Industry,Xianyang 712000,Shaanxi,CHINA【Abstract】ObjectiveTo observe the efficacy of femoral neck system(FNS)and cannulated compressionscrew(CCS)fixation under closed reduction in the treatment of femoral neck fractures,and explore its effects on peri-operative indicators and complications.MethodsA total of 108 patients with femoral neck fractures treated in De-partment of Orthopedics,No.215 Hospital of Shaanxi Nuclear Industry between January 2021 and January 2022 wereselected as the study objects.They were divided into FNS group(n=54)and CCS group(n=54)by the two-color ballrandomization method.The patients in the FNS group was given FNS fixation under closed reduction,while the pa-tients in the CCS group were given CCS fixation under closed reduction.The surgical conditions(surgical time,intraop-erative blood loss,intraoperative fluoroscopy frequency),postoperative recovery status(time of weight-bearing on theground,length of hospital stay,fracture healing time),femoral neck indicators(shortened length of femoral neck,changeof neck-shaft angle),and quality of life 36-item Short Form of Health Survey(SF-36)at 12 months after surgery werecompared between the two groups,and the hip function Hip function scale(Harris)at 6 months and 12 months af-ter surgery and occurrence of complications within 6 months after surgery were compared between the two groups.ResultsThere were no statistically significantly differences in intraoperative blood loss and length of hospital stay be-tween the two groups(P0.05).The surgical time,intraoperative fluoroscopy frequency,weight-bearing time on theground and fracture healing time in the FSN group were(79.216.38)min,(9.522.32)times,(12.423.21)weeks,(16.194.17)weeks,which were significantly shorter than(83.166.52)min,(11.273.25)times,(14.643.35)weeks,(18.234.39)weeks in the CCS group(P0.05).At 12 months after surgery,the shortened length of femoral neck andchange of neck-shaft angle in the FNS group were(2.751.05)mm,(3.501.03),which were significantly lower than(4.181.12)mm,(4.291.09)in the CCS group(P18 岁者；(3)骨折 3 周内即进行手术者；(4)认知正常且配合治疗者；(5)对本研究知情同意者。排除标准：(1)病理性骨折者；(2)髋关节发育异常者；(3)股骨头坏死者；(4)长期饮酒史或激素类药物使用史者。采用双色球随机法将患者分为 FNS 组和CCS组，每组54例。两组患者的一般资料比较差异均无统计学意义(P0.05)，具有可比性，见表1。本研究经我院医学伦理委员会批准。score between the two groups at 6 months after surgery(P0.05).At 12 months after surgery,the Harris scores in the twogroups were significantly higher than those at 6 months after surgery(P0.05).With-in 6 months after surgery,the total incidence of complications in the FSN group was 25.9%,which was slightly lowerthan 38.9%in the CCS group,but the difference was not statistically significant(P0.05).ConclusionBoth FNS andCCS under closed reduction can achieve good clinical therapeutic effects in treating femoral neck fractures,but FNS hasthe advantages of shorter surgical time,less intraoperative blood loss,faster postoperative recovery,and smaller impacton the femoral neck of patients.【Key words】Femoral neck fractures;Femoral neck system;Cannulated compression screw fixation;Periopera-tive indicators;Complications表1两组患者的一般资料比较x-s，n(%)Table 1Comparison of general data between the two groups of patients x-s,n(%)组别FNS组CCS组t/2/Z值P值例数5454男性29(53.7)26(48.1)女性25(46.3)28(51.9)0.3330.564年龄(岁)48.165.2447.595.380.5580.578受伤至手术时间(h)39.744.7940.214.360.5330.595型16(29.6)15(27.8)型28(51.9)26(48.1)型10(18.5)13(24.1)0.5260.599级37(68.5)34(63.0)级17(31.5)20(37.0)0.3700.543BMI(kg/m2)26.031.1225.781.051.1970.234性别骨折Garden分型ASA分级1.2手术方法1.2.1术前准备两组患者均给予术前X射线片、CT平扫及三维重建等检查，明确患者患侧骨折情况。两组患者手术均由高年资主治医师或更高级别医师进行。术前均给予全身麻醉或硬膜外麻醉，行闭合复位股骨颈骨折，根据患者骨折复位情况调整外展、外旋、内收及内旋角度，直至C型臂X射线机(厂家：南京卡普科技，型号：KP5000)透视骨折复位满意，并在C型臂X射线机引导下进行手术。1.2.2FNS组手术方法(1)于患者正位小转子中点水平为中心、侧位于股骨