关键词: 股骨, 股骨颈骨折, 空心加压螺钉, 经皮加压钢板, 内固定, 早期负重, 并发症

Abstract: BACKGROUND: Traditional internal fixation has a high incidence of postoperative complications in the treatment of femoral neck fractures, and early rehabilitation and weight-bearing are not advocated. Percutaneous compression plate is a new internal fixation method for the treatment of femoral neck fractures, which allows early rehabilitation and weight-bearing. The short and medium-term follow-up results showed that the risk of complications such as nonunion and head necrosis did not increase. 
OBJECTIVE: To investigate whether early postoperative weight-bearing after internal fixation of intracapsular femoral neck fractures may be taken and increases the risk of postoperative complications. 
METHODS: From January 2012 to December 2017, 90 patients with intracapsular femoral neck fractures undergoing internal fixation in the Wuxi No.9 People’s Hospital were retrospectively studied. According to the methods of internal fixation, they were divided into two groups, and each group had 45 cases. Hollow compression screws group was fixed with three hollow compression screws and taking late weight-bearing. The percutaneous compression plate group was fixed with percutaneous compression plate and taking early gradual weight-bearing. Fracture healing, internal fixation failure, head necrosis, and hip functional recovery (Harris score) were observed in both groups. Internal fixation failure, nonunion, and head necrosis were considered as overall complication. Multivariate Logistic regression was used to analyze the relationship between overall complication and age, sex, course of disease, fracture type, Pauwel angle and internal fixation method.
RESULTS AND CONCLUSION: (1) All patients were followed-up for more than 2 years. There were 5 cases of internal fixation failure, 6 cases of nonunion, 6 cases of head necrosis and 17 cases of overall complication in hollow compression screws group; while 5 cases of head necrosis, and 5 cases of overall complication without internal fixation failure or nonunion in percutaneous compression plate group. The internal fixation failure, nonunion and overall complication in percutaneous compression plate group were significantly lower than those in hollow compression screws group (P=0.011, 0.021, 0.006). The head necrosis occurred earlier in hollow compression screws group than that in percutaneous compression plate group. In terms to the head necrosis rate, there was no significant difference in the final follow-up between the two groups (P=0.748). (2) The hip functional recovery in percutaneous compression plate group was better than that in hollow compression screws group at 6 and 12 months postoperatively (P=0.000, 0.001). However, there were no significant differences at 24 months and the last follow-up between the two groups (P=0.174, 0.285). (3) Multiple Logistic Regression analysis showed that internal fixation method was the only statistically significant risk factor for overall complication. Probability of occurrence of overall complication was reduced by 73.9% in percutaneous compression plate group than that in hollow compression screws group (OR=0.261, P=0.034). (4) It is the performance of the internal fixator, not the early postoperative weight-bearing, which is related to the postoperative complications of intra-articular femoral neck fractures; the key factor to reduce the risk of postoperative complications is the reliable stable internal fixator with sliding compression effect.

Key words: femur, femoral neck fracture, hollow compression screws, percutaneous compression plate, internal fixation, early weight-bearing, complications