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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (06) : 670 -676. doi: 10.3877/cma.j.issn.1674-134X.2022.06.004

临床论著

动力抗旋交叉钉治疗不稳定股骨颈骨折的早期疗效
周晓强1, 孙超1, 李志强1, 徐人杰1, 佘远时1, 张向鑫1, 陈广祥1, 虞宵1,†()   
  1. 1. 215000　南京医科大学姑苏学院，南京医科大学附属苏州医院，苏州市立医院本部关节外科
  • 收稿日期:2022-09-07 出版日期:2022-12-01
  • 通信作者: 虞宵
  • 基金资助:
    南京医科大学姑苏学院青年骨干科学研究培育专项(GSKY20220521); 江苏省卫健委医学科研项目重点项目(K2019010)

Early results comparison on femoral neck system and cannulated screws in treatment of unstable femoral neck fractures

Xiaoqiang Zhou1, Chao Sun1, Zhiqiang Li1, Renjie Xu1, Yuanshi She1, Xiangxin Zhang1, Guangxiang Chen1, Xiao Yu1,†()   

  1. 1. Department of Joint Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou 215000, China
  • Received:2022-09-07 Published:2022-12-01
  • Corresponding author: Xiao Yu
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引用本文：

周晓强, 孙超, 李志强, 徐人杰, 佘远时, 张向鑫, 陈广祥, 虞宵. 动力抗旋交叉钉治疗不稳定股骨颈骨折的早期疗效[J]. 中华关节外科杂志(电子版), 2022, 16(06): 670-676.

Xiaoqiang Zhou, Chao Sun, Zhiqiang Li, Renjie Xu, Yuanshi She, Xiangxin Zhang, Guangxiang Chen, Xiao Yu. Early results comparison on femoral neck system and cannulated screws in treatment of unstable femoral neck fractures[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(06): 670-676.

目的

比较股骨颈动力抗旋交叉钉系统(FNS)和三枚空心螺钉治疗不稳定股骨颈骨折的早期临床疗效。

方法

回顾性分析2019年1月至2020年6月于南京医科大学附属苏州医院关节外科接受FNS或空心螺钉内固定治疗的81例Pauwels Ⅲ型股骨颈骨折患者。纳入标准：新鲜单侧闭合性股骨颈骨折，资料完整，排除标准为存在严重疾病、病理性骨折和不能配合的患者。采用配对设计研究，按照性别相同、年龄±3岁，身体质量指数±2 kg/m2，麻醉分级相同，术前血红蛋白± 10 g/L，以1 ∶1的比例匹配。FNS组26例，空心螺钉组26例为对照。采用配对t检验和确切概率法比较两组患者手术时间，术中出血量，住院时间，住院费用，术后视觉模拟评分，脱拐行走时间，髋关节功能Harris评分，欧洲5维度健康量表(EQ-5D)和并发症发生率。

结果

共成功匹配26对，所有患者平均年龄为(56±7)岁。所有患者术后复查摄片均复位满意。FNS组患者平均随访时间为(14.5±2.2)个月，空心螺钉组为(19.2±3.5)月。FNS组患者术后VAS评分为(3.2±1.1)分，空心螺钉组为(3.8±1.0)分，FNS组患者VAS评分更低(t＝0.246，P＝0.021)；FNS组患者脱拐行走时间为(5.3±1.5)月，空心螺钉组为(6.0±1.4)月，FNS组患者脱拐行走时间更早(t＝4.215，P<0.001); FNS组患者术后1年随访时Harris为(86.4±6.6)分，空心螺钉组患者为(81.9±7.6)分，FNS组患者的Harris评分更高(t＝2.486，P＝0.020)。FNS组患者术后1年随访时EQ-5D评分为(71.5±11.3)分，空心螺钉组患者为(63.9±6.8)分，FNS组患者的EQ-5D评分更高(t＝3.076，P＝0.005)。FNS组患者术中出血量(85.4±41.2)ml，空心螺钉组(29.4±8.3)ml，接受FNS的患者术中出血更多(t＝6.439，P<0.001)；FNS组住院费用(46.9±2.4)千元高于空心螺钉组的(15.7±1.8)千元(t＝47.866，P<0.001)。FNS组出现2例并发症，而空心螺钉组出现5例，两组并发症发生率差异无统计学意义(P＝0.354)。两组患者的手术时间和住院时间差异无统计学意义(P>0.05)。

结论

针对不稳定股骨颈骨折，相较于3枚空心螺钉内固定，FNS近期疗效肯定，使它成为一种全新的治疗不稳定股骨颈骨折的内固定方案，为临床治疗提供了新选择。

关键词: 股骨颈骨折, 骨折固定术，内, 内固定器, 骨螺丝
Objective

To compare the early clinical effects of femoral neck system(FNS) and three cannulated screws in the treatment of patients with unstable femoral neck fractures.

Methods

A retrospective analysis was conducted on 81 patients who received FNS or cannulated screws internal fixation for Pauwels type Ⅲ femoral neck fracture in depertment of jont surgeny of the Affiliated Suzhou Hospital of Nanjing Medical University from January 2019 to June 2020. Inclusion criteria: fresh unilateral closed femoral neck fractures with complete data. Exclusion criteria: severe diseases, pathological fractures and uncooperative patients. A pair-matched clinical research was performed. Matching requirements were as follows: the same gender, the similar age, the similar body mass index, the same American Society of Anesthesiologists grade and the similar hemoglobin. The patients who received FNS were the FNS group (26 cases) and the patients received cannulated screws were the cannulated screw group as control (26 cases). The operation time, intraoperative blood loss, hospital stay, hospitalization cost, postoperative visual analogue scale (VAS), time walking without crutches, Harris score, Europe quality of life-five dimensions questionnaire (EQ-5D ) and complication rate were compared by paired t test and exact probability method between the two groups.

Results

A total of 26 pairs were successfully matched, with an average age of (56±7) years. Postoperative re-examination of radiographs showed satisfactory reduction in all the patients. The FNS group were followed up for (14.5±2.2) months and the cannulated screw group were followed up for (19.2±3.5) months. VAS score was lower in the FNS group (3.2±1.1) than in the cannulated screw group (3.8±1.0) (t=2.461, P=0.021). The FNS group took (5.3±1.5) months recovering to walking without crutches, which was earlier than the cannulated screw group (6.0±1.4) months (t=4.215, P<0.001). The Harris scores were higher in the FNS group (86.4±6.6) than in the cannulated screw group (81.9±7.6 scores) (t=2.486, P=0.020). The postoperative EQ-5D score was higher in the FNS group (71.5±11.3) than that in the cannulated screw group (63.9±6.8) (t=3.076, P=0.005). The FNS group showed more intraoperative blood loss (85.4±41.2)ml than the cannulated screw group (29.4±8.3)ml (t=6.439, P<0.001). The FNS group spent more on hospitalization costs (46.9±2.4) thousand-yuan than the cannulated screw group (15.7±1.8) thousand-yuan (t=47.866, P<0.001). There was no significant difference in the incidence of complications between the FNS group (2/26) and the cannulated screw group (5/26) (P=0.354). There was no statistically significant difference in operation time and hospital stay between two group (P>0.05).

Conclusion

For unstable femoral neck fracture, FNS has satisfactory short-time clinical efficacy, the excellent biomechanical performance and clinical efficacy of FNS makes it a new choice for the treatment of unstable femoral neck fracture.

Key words: Femoral neck fractures, Fracture fixation, internal, Internal fixators, Bone screws
表1 两组患者的手术时间、术中出血量、住院时间和住院费用比较(±s)
组别 例数 手术时间(min) 术中出血量(ml) 住院时间(d) 住院费用(千元)
FNS组 26 42.8±4.6 85.4±41.2 5.1±1.5 46.9±2.4
空心螺钉组 26 41.1±5.3 29.3±8.3 5.2±1.5 15.7±1.8
t值 1.352 6.439 1.044 47.866
P值 >0.05 <0.001 0.306 <0.001
表2 两组患者的术后VAS评分、脱拐行走时间和EQ-5D评分比较(±s)
组别 例数 术后VAS评分(分) 脱拐行走时间(个月) EQ-5D评分(分)
FNS组 26 3.2±1.1 5.3±1.5 71.5±11.3
空心螺钉组 26 3.8±1.0 6.0±1.4 63.9±6.8
t值 2.461 4.215 3.076
P值 0.021 <0.001 0.005
表3 两组患者的术后Harris评分比较[分，(±s)]
组别 例数 疼痛 功能 髋关节活动度 Harris评分
FNS组 26 38.0±7.8 39.8±4.0 4.0±1.1 86.4±6.6
空心螺钉组 26 34.6±10.1 38.3±5.1 3.9±1.1 81.9±7.6
t值 1.633 1.392 0.367 2.486
P值 >0.05 >0.05 >0.05 0.020
图6 术后3个月复查左髋关节正侧位X线片，示骨折愈合、内固定在位稳固
[1]
张长青，张英泽，余斌，等．成人股骨颈骨折诊治指南[J]．中华创伤骨科杂志，2018，20(11)：921－928.
[2]
Wang T, Jy S, Zha GC, et al. Analysis of risk factors for femoral head necrosis after internal fixation in femoral neck fractures[J]. Orthopedics, 2014, 37(12): e1117－e1123.
[3]
周述清，朱秋汶，申洪全，等．股骨颈骨折内固定治疗的生物力学研究进展[J]．创伤外科杂志，2020，22(5)：391－394.
[4]
Chen C, Yu L, Tang X, et al. Dynamic hip system blade versus cannulated compression screw for the treatment of femoral neck fractures：a retrospective study[J]. Acta Orthop Traumatol Turc, 2017, 51(5): 381－387.
[5]
Kunapuli SC, Schramski MJ, Lee AS, et al. Biomechanical analysis of augmented plate fixation for the treatment of vertical shear femoral neck fractures[J]. J Orthop Trauma, 2015, 29(3): 144－150.
[6]
Ju FX, Hou RX, Xiong J, et al. Outcomes of femoral neck fractures treated with cannulated internal fixation in elderly patients: a long-term follow-up study[J]. Orthop Surg, 2020, 12(3): 1－10.
[7]
刘功稳，高焱，徐又佳，等．老年髋部骨折48小时内手术的疗效分析[J]．中华骨科杂志，2019，39(17)：1096－1100.
[8]
周宗科，黄泽宇，杨惠林，等．中国骨科手术加速康复围手术期氨甲环酸与抗凝血药应用的专家共识[J]．中华骨与关节外科杂志，2019，12(2)：81－88.
[9]
Haidukewych GJ, Rothwell WS, Jacofsky DJ, et al. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years[J]. J Bone Joint Surg Am, 2004, 86(8): 1711－1716.
[10]
骆洪涛，郑力通，闫伟，等．欧洲五维度健康量表评估老年髋部骨折术后生活质量变化研究[J/CD]．中华关节外杂志(电子版)，2015，9(2)：200－204.
[11]
Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young adults[J]. J Bone Joint Surg Am, 2008, 90(10): 2254－2266.
[12]
李智浩，张绍安，远东涛，等．直接前方入路切开复位空心钉内固定治疗青壮年难复性股骨颈骨折[J]．中华骨与关节外科杂志，2019，12(11)：868－872.
[13]
FAITH-2 Investigators, Slobogean GP, SpragueS, et al. Fixation using alternative implants for the treatment of hip fractures (FAITH-2): design and rationale for a pilot multi-centre 2 × 2 factorial randomized controlled trial in young femoral neck fracture patients[J]. Pilot Feasibility Stud, 2019, 5(1): 70－83.
[14]
赵丽坤，崔爽爽，马剑雄，等．成年股骨颈骨折临床特征分析：一项基于医院的回顾性研究[J]．中华骨科杂志，2021，41(3)：157－164.
[15]
Guyen O. Hemiarthroplasty or total hip arthroplasty in recent femoral neck fractures? [J]. Orthop Traumatol Surg Res, 2019, 105(1)：95－101.
[16]
Kim SJ, Park HS, Lee DW. Complications after internal screw fixation of nondisplaced femoral neck fractures in elderly patients: a systematic review[J]. Acta Orthop Traumatol Turc, 2020, 54(3): 337－343.
[17]
Wang Y, Ma JX, Yin T, et al. Correlation between reduction quality of femoral neck fracture and femoral head necrosis based on biomechanics[J]. Orthop Surg, 2019, 11(2): 318－324.
[18]
李磊，朱晨，方诗元，等．股骨颈骨折空心钉内固定术后长期疗效分析[J/CD]．中华关节外科杂志(电子版)，2018，12(3)：10－15.
[19]
Davidovitch RI, Jordan CJ, Egol KA, et al. Challenges in the treatment of femoral neck fractures in the nonelderly adult[J]. J Trauma, 2010, 68(1): 236－242.
[20]
Liporace F, Gaines R, Collinge C, et al. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures[J]. J Bone Joint Surg Am, 2008, 90(8): 1654－1659.
[21]
Hoskinson S, Morison Z, Shahrokhi S, et al. Managing AVN following internal fixation：treatment options and clinical results[J]. Injury, 2015, 46(3): 497－506.
[22]
Panteli M, Rodham P, Giannoudis PV. Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly[J]. Injury, 2015, 46(3): 445－452.
[23]
Stoffel K, Zderic I, Gras F, et al. Biomechanical evaluation of the femoral neck system in unstable pauwels III femoral neck fractures: a comparison with the dynamic hip screw and cannulated screws[J]. J Orthop Trauma, 2017, 31(3): 131－137.
[24]
许新忠，常菁，余水生，等．股骨颈系统固定治疗股骨颈骨折的近期疗效分析[J]．中华创伤骨科杂志，2020，22(7)：624－627.
[25]
Dargan DP, Callachand F, Diamond OJ, et al. Three-year outcomes of intracapsular femoral neck fractures fixed with sliding hip screws in adults aged under sixty-five years[J]. Injury, 2016, 47(11): 2495－2500.
[26]
van Walsum A, Vroemen J, Janzing H, et al. Low failure rate by means of DLBP fixation of undisplaced femoral neck fractures[J]. Eur J Trauma Emerg Surg, 2017, 43(4): 475－480.
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