两种内固定方式治疗中青年不稳定型股骨颈骨折疗效比较

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摘要目的〓比较股骨颈动力交叉钉系统(femoral neck system，FNS)和多枚空心加压螺钉技术(multiple cannulated screws，MCS)治疗中青年不稳定型股骨颈骨折的中短期疗效及预后。方法〓回顾性分析2020年10月至2023年10月符合标准的112例中青年股骨颈骨折患者资料，根据骨折内固定治疗方式选择分为FNS组及MCS组。其中FNS组共55例，男21例，女34例；年龄33~65岁，平均(56.05±7.53)岁。MCS组共57例，男24例，女33例；年龄29~65岁，平均(55.04±8.32)岁。对两组的基线资料进行分析；通过比较两组手术切口长度、手术时间、术中失血量、术中透视时间、辅助复位情况等围手术期指标来分析两组在手术相关数据方面的差别；通过比较两组在随访时间、住院天数、负重时间、Harris髋关节评分、疼痛视觉模拟评分、并发症以及术后3个月和6个月后股骨颈骨折短缩等数据的组间差异来评估两组疗效的差别。结果〓112例患者中111例患者获得完整随访，随访时间24~144周，FNS组平均(74.17±36.76)周，MCS组平均(77.75±32.49)周。FNS组骨折愈合时间(13.20±2.13)周较MCS组(15.39±4.42)周更短(P＜0.05)，而FNS组完全负重时间(11.76±4.22)周也较MCS组(19.39±4.42)周更早(P＜0.05)，同时FNS组术后股骨颈短缩长度以及髋关节功能评分也优于MCS组(P＜0.05)。在术后并发症比较中，FNS组也具有更低的术后内固定失败率(1.82%)，而在两组其他围手术期、术后疗效及术后并发症数据的比较中，其组间差异无统计学意义(P＞0.05)。结论〓与传统MCS技术相比，在治疗中青年不稳定型股骨颈骨折中FNS技术不仅拥有微创手术的技术优势，同时其更好的静态稳定及动态加压效果，也允许患者进行早期负重及康复锻炼，并降低了术后并发症的发生率。

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	王秋霏1
	陶华强2*
	顾叶1*
	彭育沁1
	巨荣1
	黄梦娜1
	朱志宏1
	朱锋2
	王熠军2
	耿德春2
	徐耀增2

关键词 ：股骨颈骨折, 手术治疗, 股骨颈动力交叉钉系统, 多枚空心加压螺钉系统

Abstract：Objective〓To compare the short and medium term efficacy and prognosis of femoral neck dynamic cross napping system and multiple hollow compression screws in the treatment of young and middle-aged unstable femoral neck fractures.
Methods〓A retrospective analysis was conducted on data from 112 patients who sustained femoral neck fractures and met the inclusion criteria between October 2020 and October 2023.The patients were divided into two treatment groups based on the surgical approach：femoral neck system (FNS) and multiple cannulated screws (MCS).The FNS group comprised 55 patients，including 21 males and 34 females，with a mean age of (56.05±7.53)years (ranging from 33 to 65 years).The MCS group included 57 patients，comprising 24 males and 33 females，with a mean age of (55.04±8.32)years (ranging from 29 to 65 years).Initially，baseline characteristics of both groups were compared.Subsequently，perioperative indicators，such as surgical incision length，operative time，intraoperative blood loss，fluoroscopy time，and the need for assisted reduction，were analyzed to identify differences in surgical data between the FNS and MCS groups.Additionally，follow-up outcomes，including hospital stay，time to weight-bearing，Harris hip scores，visual analogue scale (VAS) pain scores，and postoperative complications，were evaluated.Finally，changes in femoral neck shortening at 3 and 6 months post-surgery were assessed to determine the effectiveness of each treatment modality.Statistical comparisons were made to evaluate the differences in outcomes between the FNS and MCS groups.
Results〓Among the 112 patients，111 patients completed follow-up for a period ranging from 24 to 144 weeks.The mean follow-up time was (74.17±36.76)weeks in the FNS group and (77.75±32.49)weeks in the MCS group.Comparative analysis revealed that the fracture healing time in the FNS group (13.20±2.13)weeks was significantly shorter than that in the MCS group (15.39±4.42)weeks (P＜0.05).Similarly，the complete weight-bearing time in the FNS group (11.76±4.22)weeks was earlier than that in the MCS group (19.39±4.42)weeks (P＜0.05).Furthermore，the femoral neck shortening length and hip function scores，as assessed by the Harris hip score，were significantly better in the FNS group compared to the MCS group (P＜0.05).In terms of postoperative complications，the FNS group exhibited a lower rate of internal fixation failure (1.82%)，although this difference did not reach statistical significance when compared to the MCS group.Notably，no statistically significant differences were observed between the two groups in terms of other perioperative parameters，postoperative outcomes，or the overall incidence of complications (P＞0.05).Conclusion〓When compared to the conventional MCS technique，the FNS technique offers several advantages in the treatment of unstable femoral neck fractures in middle-aged and young adults.Specifically，it embodies the technical merits of minimally invasive surgery，providing both better static stability and a dynamic compression effect.These attributes enable patients to commence early weight-bearing and rehabilitation exercises，thereby potentially reducing the incidence of postoperative complications.

Key words： femoral neck fracture surgical treatment femoral neck system multiple cancellous screws

基金资助:常熟市卫健委科技计划项目(cs202119)

通讯作者: 顾叶

作者简介: 王秋霏(1988－ )，男，主治医师，苏州大学附属常熟医院，常熟市第一人民医院骨科，cswqfei@126.com

引用本文:

王秋霏1，陶华强2*，顾叶1*，彭育沁1，巨荣1，黄梦娜1，朱志宏1，朱锋2，王熠军2，耿德春2，徐耀增2. 两种内固定方式治疗中青年不稳定型股骨颈骨折疗效比较[J]. 实用骨科杂志, 2024, 30(7): 611-.
Wang Qiufei1，Tao Huaqiang2*，Gu Ye1*，Peng Yuqin1，Ju Rong1，Huang Mengna1，Zhu Zhihong1，Zhu Feng2，Wang Yijun2，Geng Dechun2，Xu Yaozeng2. Comparison of the Efficacy of Two Internal Fixation Methods in the Treatment of Unstable Femoral Neck Fracture in Young and Middle-Aged Patients. sygkzz, 2024, 30(7): 611-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2024/V30/I7/611

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