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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2020, Vol. 06 ›› Issue (05) : 251 -256. doi: 10.3877/cma.j.issn.2096-0263.2020.05.002

所属专题： 文献；

股骨骨折

比基尼入路切开复位PFNA与闭合空心钉治疗青壮年股骨颈骨折的疗效比较
周孝乾1, 田智勇1, 陈洪强1, 鄢承元1,†(), 叶赟1, 周翔1, 周军1   
  1. 1. 550002　贵阳市第四人民医院-创伤与关节外科
  • 收稿日期:2019-12-12 出版日期:2020-10-05
  • 通信作者: 鄢承元
  • 基金资助:
    贵阳市卫生健康局科学技术计划项目(【2018】筑卫计科技合同字第011号)

Comparative Studies on the Use of PFNA associated with open reduction and cannulated screws with closed reduction in femoral neck fractures in young adults

Xiaoqian Zhou1, Zhiyong Tian1, Hongqiang Chen1, Chengyuan Yan1,†(), Yun Ye1, Xiang Zhou1, Jun Zhou1   

  1. 1. Department of Trauma and Joint Surgery, the Forth People’s Hospital of Guiyang City, Guiyang 550002, China
  • Received:2019-12-12 Published:2020-10-05
  • Corresponding author: Chengyuan Yan
  • About author:
    Corresponding author: Yan Chengyuan, Email:
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周孝乾, 田智勇, 陈洪强, 鄢承元, 叶赟, 周翔, 周军. 比基尼入路切开复位PFNA与闭合空心钉治疗青壮年股骨颈骨折的疗效比较[J]. 中华老年骨科与康复电子杂志, 2020, 06(05): 251-256.

Xiaoqian Zhou, Zhiyong Tian, Hongqiang Chen, Chengyuan Yan, Yun Ye, Xiang Zhou, Jun Zhou. Comparative Studies on the Use of PFNA associated with open reduction and cannulated screws with closed reduction in femoral neck fractures in young adults[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2020, 06(05): 251-256.

目的

探讨比基尼入路切开复位股骨近端防旋髓内钉（PFNA）与闭合空心钉治疗青壮年股骨颈骨折的临床疗效及可行性。

方法

回顾性分析自2016年1月至2019年2月采用比基尼入路切开直视下复位PFNA，必要时植骨术（PFNA组，28例）与采用闭合空心钉（空心钉组，30例）治疗的青壮年股骨颈骨折患者的临床资料，对比分析两组患者的手术情况、下地时间、骨折愈合时间及并发症情况。

结果

所有患者均获得随访，平均随访时间为（12±4）个月，随访期间无死亡病例，伤口无感染，PFNA组手术时间、术中出血量、术后1个月VAS评分分别为（45±19）min、（81±36）ml、（1.0±1.5）分，空心钉组分别为（31±13）min、（36±20）ml、（0.8±1.5）分，差异无统计学意义（均P>0.05），PFNA组下地时间[（1.8±1.3）d]少于空心钉组[（10.2±8.7）d]（P<0.05），PFNA组骨折愈合时间为（2.8±1.3）个月，1例出现退钉，10个月后取出内固定器，空心钉组为（4.0±1.8）个月，2例出现骨不连，二期行全髋关节置换，1例退钉愈合，余骨折均随访愈合，无股骨头坏死发生。术后1个月Harris评分：PFNA组，优18例，良6例，中3例，差1例，优良率达85.7%，空心钉组，优14例，良11例，中2例，差3例，优良率达83.3%。

结论

空心钉与PFNA均能有效治疗青壮年股骨颈骨折。空心钉组不能早期下地负重活动，股骨头坏死率高；PFNA组骨折愈合率高，能早期下地活动，骨折卧床并发症减少，符合加速康复外科理念，是治疗青壮年股骨颈骨折的有效治疗方法。

关键词: 股骨颈骨折, 股骨近端防旋髓内钉, 比基尼入路, 空心钉
Objective

To evaluate the clinical results of conferring PFNA with open reduction and cannulated screws with closed reduction in femoral neck fracture in young adults.

Methods

To analyze the admitted young patients that consist of 28 cases open reduction and 30 cases closed reduction from January 2016 to February 2019 in our hospital retrospectively. The operation condition, the time of the down ground, the time of fracture healing and the complications of the two groups were compared and analyzed.

Results

No infection and dead patients were found in the series of study. There was no significant difference between the PFNA group and the screw group in the time and the bleeding during the operation (P>0.05), while there was significant difference when come to the weight bearing time (P<0.05). The mean time of union was (2.8±1.3) months in the PFNA group, however, one case of blade depinning was found and then removed the fixation 10 months postoperatively. Contrastively, the average union time of Screw group was (4.0±1.8) months, two cases of nonunion had been underwent the THA revision. No femoral head avascular necrosis was found in both group.

Conclusions

Both canulated screw and PFNA can effectively treat femoral neck fracture in young adults. The cannulated screw group should not be used for early weight bearing and the incidence of femoral head necrosis in this group is more higher than PFNA group; PFNA group patients not only have more higher incidence of bone union and more early full weight bearing time but also have lower incidence of fracture complications, which is fit for the ERAS concept and is a effectively treatment for femoral neck fracture in young adults.

Key words: Femoral neck fractures, Proximal femoral nail antirotation, Cannulated screws
表1 两组股骨颈骨折患者一般资料比较
组别 例数 手术时间（min， ±s） 出血量（ml， ±s） 术后1个月VAS评分（分， ±s） 下地时间（d， ±s） 术后1个月髋关节Harris评分（例）
优 良 中 差
PFNA组 28 45±19 81±36 1.0±1.5 1.8±1.3 18 6 3 1
空心钉组 30 31±13 36±20 0.8±1.5 10.2±8.7 14 11 2 3
统计值 ? t=0.138 t=0.431 t=0.275 t=-10.273 Z=-0.430
P值 ? 0.546 0.893 0.769 0.0001 0.781
图3~4 女性，59岁，右股骨颈骨折Garden分型Ⅳ型闭合复位空心钉内固定。图3术前X线片；图4术后X线片
表2 两组股骨颈骨折患者术后相关指标及Harris评分比较
组别 例数 性别（例） 年龄（岁， ±s） 骨折Garden分型（例） 损伤原因（例） 受伤天数（d， ±s）
男 女 Ⅰ Ⅱ Ⅲ Ⅳ 摔跌 车祸 高坠
PFNA组 28 13 15 35±5 2 6 12 10 21 2 5 2.8±1.0
空心钉组 30 11 19 36±4 3 3 9 13 24 2 4 3.1±1.0
统计值 ? χ2=0.569 χ2=-0.607 χ2=1.953 χ2=0.242 χ2=-0.896
P值 ? 0.451 0.546 0.582 0.886 0.374
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