| 张治浩,管东辉.股骨颈复合加压系统治疗股骨颈骨折的近期疗效观察[J].浙江中西医结合杂志,2023,33(3): |
| 股骨颈复合加压系统治疗股骨颈骨折的近期疗效观察 |
| Observation of short-term curative effect of femoral neck compound compression system in the treatment of femoral neck fractures |
| 投稿时间：2022-03-02 修订日期：2022-12-11 |
| DOI： |
| 中文关键词: 股骨颈骨折、股骨颈复合加压系统、空心螺钉、微创、内固定 |
| 英文关键词:femoral neck fracture, femoral neck composite compression system, cannulated screw, minimally invasive, internal fixation |
| 基金项目:山东省中医药科技发展计划项目(编号:2019-0144) |
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| 中文摘要: |
| 目的 探讨股骨颈复合加压系统（Compound compression system,CCS）。与空心加压螺钉（cannulate compression screw，CCS）治疗股骨颈骨折的手术方法与近期疗效。方法 回顾性分析自2020年12月至2021年12月收治的股骨颈骨折患者32例，其中股骨颈复合加压系统组11例，空心加压螺钉组21例，患者骨折类型包括Garden分型Ⅰ～Ⅳ型。股骨颈复合加压系统组男3例，女8例；年龄32 ～ 70岁；空心加压螺钉组男10例，女11例；年龄 30～70岁。记录并比较两组的手术时间、术中透视次数、术中出血量、住院时间、Garden指数、骨折愈合时间、术后3个月、术后6个月时髋关节Harris评分、术后并发症情况（股骨头坏死、患肢缩短、骨折不愈合等）。结果 两组共32位患者全部获得随访，随访时间6～12个月。两组患者性别、年龄、致伤原因、侧别、骨折分型（Garden 分型）等一般资料比较，差异均无统计学意义（P>0.05）。两组的住院时间、Garden指数比较，差异均无统计学意义（P＞0.05）。股骨颈复合加压系统组术中透视次数低于空心加压螺钉组，差异具有统计学意义（P＜0.05）；股骨颈复合加压系统组术中出血量高于空心加压螺钉组，差异具有统计学意义（P＜0.05）；股骨颈复合加压系统组骨折愈合时间短于空心加压螺钉组，差异有统计学意义（P＜0.05）；股骨颈复合加压系统组术后患肢缩短情况优于空心加压螺钉组（P＜0.05）。两组患者术后3个月随访时股骨颈复合加压系统组Harris评分比优于空心加压螺钉组（P＞0.05）；两组患者术后6个月随访时，Harris评分比较，差异无统计学意义（P＞0.05）。股骨颈复合加压系统组患者随访期间均无股骨头坏死、骨折不愈合等并发症发生；空心加压螺钉组随访期间1例患者出现股骨头坏死，后期予以髋关节置换术，术后患者恢复良好。股骨颈复合加压系统组退钉均小于5mm，患者无不适症状；空心加压螺钉组退钉明显多于组，且有3例患者退钉超过8mm，出现大腿外侧激惹症状，侧卧及行走时存在疼痛等不适症状。结论 与空心加压螺钉相比较股骨颈复合加压系统具有术中透视次数少、骨折愈合时间短等优点，且术后股骨颈短缩及退钉情况较空心加压螺钉大为改善，股骨颈复合加压系统内固定物具有生物力学的稳定性，有利于患者早期活动，改善患者预后，达到满意的临床疗效。 |
| 英文摘要: |
| Abstract：Objective To investigate the compound compression system of the femoral neck. Surgical method and short-term effect of treating femoral neck fracture with cannulate compression screw Methods A retrospective analysis of 32 patients with femoral neck fractures admitted from December 2020 to December 2021, including 11 cases in the femoral neck compound compression system group and 21 cases in the cannulated compression screw group, the fracture types included Garden classification I ~ IV type.The femoral neck compound compression system group included 3 males and 8 females, aged 32 to 70 years; the cannulated compression screw group included 10 males and 11 females, aged 30 to 70 years. The operation time, intraoperative fluoroscopy times, intraoperative blood loss, hospital stay, Garden index, fracture healing time, hip Harris score at 3 months and 6 months after operation, and postoperative complications were recorded and compared between the two groups. Condition (femoral head necrosis, shortened limb, nonunion, etc.).Results A total of 32 patients in the two groups were followed up for 6 to 12 months. There was no significant difference in the general data such as gender, age, cause of injury, side, and fracture classification (Garden classification) between the two groups (P>0.05). There was no significant difference in hospitalization time and Garden index between the two groups (P>0.05).The intraoperative fluoroscopy times in the femoral neck compound compression system group was lower than that in the cannulated compression screw group, and the difference was statistically significant (P<0.05). There was statistical significance (P<0.05); the fracture healing time of the femoral neck compound compression system group was shorter than that of the cannulated compression screw group, and the difference was statistically significant (P<0.05); The shortening was better than that of the cannulated compression screw group (P<0.05). The Harris score ratio of the femoral neck composite compression system group was better than that of the cannulated compression screw group at the 3-month follow-up between the two groups (P>0.05); there was no difference in the Harris score between the two groups at the 6-month follow-up. Statistical significance (P>0.05).No complications such as femoral head necrosis and nonunion occurred in the femoral neck compound compression system group during the follow-up period; femoral head necrosis occurred in 1 patient in the cannulated compression screw group during the follow-up period. Later, hip replacement was performed, and the patient recovered after operation. good. The screw retraction in the femoral neck compound compression system group was less than 5 mm, and the patients had no symptoms of discomfort; the screw retraction in the cannulated compression screw group was significantly more than that in the cannulated compression screw group, and 3 patients had screw retraction more than 8 mm, and had symptoms of irritation on the lateral side of the thigh. Pain and other discomfort symptoms when walking.Conclusion Compared with the cannulated compression screw, the femoral neck composite compression system has the advantages of less intraoperative fluoroscopy, shorter fracture healing time, etc., and the postoperative shortening of the femoral neck and screw retraction are greatly improved. The internal fixator of the compound compression system has biomechanical stability, which is conducive to the early movement of patients, improves the prognosis of patients, and achieves satisfactory clinical efficacy. |
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