中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (4): 583-587.doi: 10.12307/2023.202

• 骨科植入物 orthopedic implant • 上一篇    下一篇

动力髋螺钉加防旋螺钉及股骨颈系统内固定治疗Garden Ⅱ-Ⅳ型股骨颈骨折的比较

洪  潇1，罗  鸿1，杨若男2   

  1. 贵州省骨科医院，1骨外二科，2影像医学科，贵州省贵阳市   550001
  • 收稿日期:2021-11-10 接受日期:2022-01-25 出版日期:2023-02-08 发布日期:2022-06-23
  • 通讯作者: 罗鸿，副主任医师，贵州省骨科医院骨外二科，贵州省贵阳市 550001
  • 作者简介:洪潇，男，1985年生，贵州省贵阳市人，苗族，主治医师，主要从事下肢创伤研究。
  • 基金资助:
    贵州省科技计划项目(黔科合支[2018]2763)，项目负责人：罗鸿

Comparison of dynamic hip screw and anti-rotation screw internal fixation and femoral neck system internal fixation in the treatment of Garden II-IV femoral neck fracture

Hong Xiao1, Luo Hong1, Yang Ruonan2   

  1. 1Second Department of Orthopedic Surgery, 2Department of Imaging Medicine, Guizhou Orthopedic Hospital, Guiyang 550001, Guizhou Province, China
  • Received:2021-11-10 Accepted:2022-01-25 Online:2023-02-08 Published:2022-06-23
  • Contact: Luo Hong, Associate chief physician, Second Department of Orthopedic Surgery, Guizhou Orthopedic Hospital, Guiyang 550001, Guizhou Province, China
  • About author:Hong Xiao, Attending physician, Second Department of Orthopedic Surgery, Guizhou Orthopedic Hospital, Guiyang 550001, Guizhou Province, China
  • Supported by:
    the Science and Technology Project of Guizhou Province, No. [2018]2763 (to LH)

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摘要：

文题释义：
股骨颈系统：其采用微创手术治疗股骨颈骨折，手术并发症少、术后稳定性强、预后较好，可减少术后内固定失效、骨折移位等并发症的发生率，降低患者医疗费用，减少患者痛苦。该技术的主要特点是创伤更小、稳定性佳，从生物力学的角度来看，股骨颈系统是治疗不稳定股骨颈骨折的有效方法，其稳定性与动力髋螺钉相当，并优于空心螺钉。
股骨颈骨折：临床上主要以手术治疗为主，但术后并发症中常出现股骨颈短缩、骨折不愈合、髋内外翻畸形、股骨头坏死等情况。临床上有多种股骨颈内固定器材，在选择方面无统一的标准。使用3枚空心螺钉进行内固定的优点是微创、抗旋转力好，但在Pauwels角 > 50°的情况下骨折不稳定，3枚空心螺钉的力学性能不佳。

背景：动力髋螺钉加防旋螺钉内固定治疗股骨颈骨折的生物力学强度高于空心螺钉，但未能体现微创原则；股骨颈系统采用微创手术治疗股骨颈骨折，手术并发症少、术后稳定性强、预后较好，可减少术后内固定失效、骨折移位等并发症的发生率。
目的：对比动力髋螺钉加防旋螺钉与股骨颈系统内固定治疗Garden Ⅱ-Ⅳ型股骨颈骨折的近期疗效。
方法：选择贵州省骨科医院2019年1月至2021年2月收治的Garden Ⅱ-Ⅳ型股骨颈骨折患者，共纳入93例，年龄24-79岁，采用随机数字表法分为对照组(n=43)和试验组(n=50)，对照组置入动力髋螺钉加防旋螺钉进行骨折固定与复位，试验组应用股骨颈系统进行骨折固定与复位。记录两组切口大小、出血量、手术时间、透视次数及骨折复位情况。术后随访观察骨折愈合时间、目测类比评分、Harris评分、并发症发生及再次手术情况。
结果与结论：①试验组切口长度、出血量、手术时间、透视次数均少于对照组P < 0.05)，两组患者骨折复位良好，复位等级比较差异无显著性意义(P > 0.05)；②两组患者均完成6个月术后随访，两组内固定失败、骨折不愈合、股骨头坏死的发生率比较差异无显著性意义(P > 0.05)，术后并发症的总发生率、再次手术率比较差异无显著性意义(P > 0.05)；③两组骨折愈合时间比较差异无显著性意义(P > 0.05)；两组治疗后6个月的Harris评分、目测类比评分均较治疗前明显改善(P < 0.05)，两组间治疗后6个月的Harris评分、目测类比评分比较差异均无显著性意义(P > 0.05)；④结果表明，动力髋螺钉加防旋螺钉与股骨颈系统治疗股骨颈骨折的力学性能均良好，但股骨颈系统内固定的优势体现在操作简便、透视次数少、手术时间短、创伤小、出血量少。

https://orcid.org/0000-0003-4969-8086 (洪潇)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 动力髋螺钉, 防旋螺钉, 股骨颈系统, 股骨颈骨折, 内固定, 疗效

Abstract: BACKGROUND:  The biomechanical strength of dynamic hip screw plus anti-rotation screw internal fixation for femoral neck fracture is higher than that of cannulated screw, but it fails to reflect the principle of minimally invasive surgery. Femoral neck system with minimally invasive surgery for the treatment of femoral neck fractures has few surgical complications, strong postoperative stability and good outcomes, and can reduce the incidence of complications such as internal fixation failure and fracture displacement.
OBJECTIVE: To compare the short-term effects of dynamic hip screw plus anti-rotation screw internal fixation and femoral neck system internal fixation in the treatment of Garden II-IV femoral neck fracture. 
METHODS: Totally 93 patients with Garden II-IV femoral neck fractures in the Guizhou Orthopedic Hospital from January 2019 to February 2021 were enrolled in this study. They were at the age of 24-79 years. All patients were randomly divided into control group (n=43) and trial group (n=50). The control group was implanted with dynamic hip screws and anti-rotation screws for fracture fixation and reduction, while the trial group was implanted with femoral neck system for fracture fixation and reduction. The incision size, blood loss, operation time, fluoroscopy times, and fracture reduction were recorded in both groups. Fracture healing time, Harris score, visual analogue scale score, the incidence of complications, and the rate of reoperation in the two groups were observed after operation. 
RESULTS AND CONCLUSION: (1) Incision length, blood loss, operation time, and fluoroscopy times were less in the trial group than those in the control group (P < 0.05). The fracture reduction was good in both groups, and there was no significant difference between the two groups (P > 0.05). (2) Both groups completed the 6-month postoperative follow-up. There was no significant difference in the incidence of internal fixation failure, fracture nonunion and femoral head necrosis between the two groups (P > 0.05). There was no significant difference in the total incidence of postoperative complications and reoperation rate between the two groups (P > 0.05). (3) There was no significant difference in the fracture healing time between the two groups (P > 0.05). Harris score and visual analogue scale score 6 months after treatment in the two groups were significantly improved compared with those before treatment (P < 0.05). There was no significant difference in Harris score and visual analogue scale score between the two groups 6 months postoperatively (P > 0.05). (4) These findings suggest that the mechanical properties of dynamic hip screw plus screw and femoral neck system are good, but the advantages of femoral neck system internal fixation are simple operation, less fluoroscopy, short operation time, less trauma and less bleeding. 

Key words: dynamic hip screw, anti-rotation screw, femoral neck system, femoral neck fracture, internal fixation, curative effect

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