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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 ›› 2024, Vol. 10 ›› Issue (05) : 281 -286. doi: 10.3877/cma.j.issn.2096-0263.2024.05.004

髋部骨折

2枚与3枚空心钉治疗无移位股骨颈骨折的疗效对比
张于1, 程亮亮1, 王峰1, 赵德伟1,†()   
  1. 1. 116001　大连大学附属中山医院骨科
  • 收稿日期:2023-11-02 出版日期:2024-10-05
  • 通信作者: 赵德伟
  • 基金资助:
    大连市重点医学专业建设基金项目"登峰计划"

Comparison of clinical efficacy between two versus three cannulated compression screws for the treatment of femoral neck fractures without displacement

Yu Zhang1, Liangliang Cheng1, Feng Wang1, Dewei Zhao1,†()   

  1. 1. Department of Orthopedics, Zhongshan Hospital, Dalian University, Dalian 116001, China
  • Received:2023-11-02 Published:2024-10-05
  • Corresponding author: Dewei Zhao
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引用本文：

张于, 程亮亮, 王峰, 赵德伟. 2枚与3枚空心钉治疗无移位股骨颈骨折的疗效对比[J]. 中华老年骨科与康复电子杂志, 2024, 10(05): 281-286.

Yu Zhang, Liangliang Cheng, Feng Wang, Dewei Zhao. Comparison of clinical efficacy between two versus three cannulated compression screws for the treatment of femoral neck fractures without displacement[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2024, 10(05): 281-286.

目的

比较运用2枚空心拉力螺钉与3枚空心拉力螺钉治疗无移位股骨颈骨折的临床疗效。

方法

回顾性分析2017年1月至2020年12月期间我院采用空心钉内固定治疗的85例无移位股骨颈骨折患者资料。根据固定螺钉数量不同分为2枚空心拉力螺钉组及3枚空心拉力螺钉组。比较两组患者手术时间、术中出血量、骨折愈合时间，术后6个月髋关节评分及骨坏死、骨折不愈合等并发症。

结果

69例患者获得随访，2枚空心拉力螺钉组32例，随访时间（25.8±4.1）个月。男19例，女13例，平均年龄（48.71±12.6）岁，3枚空心拉力螺钉组37例，随访时间（27.9±5.2）个月。男21例，女16例，平均年龄（50.32±9.4）岁。2枚空心拉力螺钉组分别在手术时间（44.7±7.1) min、术中出血量（83.5±8.6）ml方面优于3枚空心拉力螺钉组（48.3±3.9）min及（88.6±7.9）ml，术后骨坏死发病率2枚空心拉力螺钉组（21.88%）显著低于3枚空心拉力螺钉组（35.14%），差异具有统计学意义（P<0.001）；而在骨折愈合时间及髋关节评分方面无明显统计学差异。

结论

对于GardenⅠ、Ⅱ型无移位股骨颈骨折，2枚空心拉力螺钉能够提供足够固定强度、早期进行功能康复，同时减少对股骨头内血运的破坏，显著降低术后骨坏死发生率。

关键词: 股骨颈骨折, 空心钉, 无移位骨折
Objective

To compare the clinical efficacy of treating non-displaced femoral neck fractures with two versus three cannulated compression screws.

Methods

A retrospective analysis was conducted on 85 patients with non-displaced femoral neck fractures treated with cannulated screws in our hospital from January 2017 to December 2020. The patients were divided into two groups based on the number of fixation screws: the two-screw group and the three-screw group. The two groups were compared in terms of operation time, intraoperative blood loss, fracture healing time, hip joint scores at 6 months postoperatively, and complications such as osteonecrosis and nonunion.

Results

Sixty-nine patients were followed up; 32 in the two-screw group, with a follow-up period of 25.8±4.1 months. This group included 19 males and 13 females, with an average age of (46.3±10.1) years. The three-screw group comprised 37 patients, with a follow-up period of (27.9±5.2) months, including 21 males and 16 females, with an average age of (48.1±7.7) years. The two-screw group showed better results in operation time (44.7±7.1) minutes and intraoperative blood loss (83.5± 8.6 ml) compared to the three-screw group (48.3±3.9) minutes and (88.6±7.9) ml, respectively. The incidence of postoperative osteonecrosis in the two-screw group (21.88%) was significantly lower than in the three-screw group (35.14%) (P<0.001). No significant statistical difference was observed in fracture healing time and hip joint scores.

Conclusions

For Garden I and II type non-displaced femoral neck fractures, two cannulated compression screws can provide sufficient fixation strength, allow early functional rehabilitation, and reduce the destruction of intraosseous blood supply to the femoral head, significantly lowering the rate of postoperative osteonecrosis.

Key words: Femoral neck fractures, Cannulated screws, Fractures without displacement
图1 空心拉力螺钉外观图片
表1 两组无移位股骨颈骨折患者一般资料比较
组别 例数 年龄（岁，±s） 性别[例（%）] 患髋[例（%）] 受伤机制[例（%）] Garden分型[例（%）]
男性 女性 左侧 右侧 高能量损伤 低能量损伤 Ⅰ型 Ⅱ型
2枚钉 32 48.71±12.6 19（59.4） 13（40.6） 16（50.0） 16（50.0） 3（9.43） 29（90.6） 10（31.3） 22（68.7）
3枚钉 37 50.32±9.4 21（56.8） 16（43.2） 20（54.1） 17（45.9） 4（10.8） 33（89.2） 22（59.4） 15（40.5）
统计值   t=0.689 t=5.000 t=1.673 t=1.833 t=0.265
P值   0.573 0.126 0.348 0.523 0.847
表2 2枚钉组与3枚钉组患者手术时间、术中出血量及骨折愈合时间比较（±s）
组别 例数 手术时间（min） 术中出血量（ml） 骨折愈合时间（月）
2枚钉 32 44.7±7.1 83.5±8.6 3.7±0.9
3枚钉 37 48.3±3.9 88.6±7.9 3.8±0.7
t值   7.371 9.466 0.195
P值   <0.0001 <0.0001 0.845
表3 2枚钉组与3枚钉组患者术后髋关节评分、骨折不愈合率及骨坏死率比较（±s）
组别 例数 髋关节评分（分） 骨折不愈合率（%） 骨坏死率（%）
2枚钉 32 84.8±4.7 3.13 21.88
3枚钉 37 83.9±3.2 5.41 35.14
统计值   t=1.231 χ2=0.689 χ2=24.37
P值   0.297 0.528 <0.0001
图2 图A-C　患者女性，55岁，Garden Ⅰ型外展嵌插型左侧股骨颈骨折，2枚空心拉力螺钉固定。图A　术前X线片；图B　术后3个月骨折愈合良好；图C　随访至术后27个月未见骨坏死发生　图D-F　患者女性，46岁，GardenⅡ型左侧股骨颈骨折，3枚空心拉力螺钉固定。图D　术前X线片；图E　术后3.5个月骨折愈合；图F　术后11个月随访发现股骨头坏死
图3 患者男性，32岁，Garden Ⅰ型右侧股骨颈骨折。图A　术后X线片；图B　术后DSA显示股骨头内骺动脉血管网缺乏血供；图C　术后20个月发现股骨头上方出现坏死、塌陷
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