摘要
背景:PauwelsⅢ型股骨颈骨折具有较高的垂直剪切力、术后并发症发生率高等特征,是一种典型的不稳定骨折。目前治疗PauwelsⅢ型骨折固定方式较多,何种内固定为青壮年PauwelsⅢ股骨颈骨折的最佳固定方式,尚无明确结论。目的:比较3枚倒三角空心螺钉辅助横形拉力螺钉、股骨颈系统固定PauwelsⅢ型青壮年股骨颈骨折的临床效果。方法:选择2021年5月至2022年12月于西南医科大学附属医院就诊,采用3枚倒三角空心螺钉辅助横形拉力螺钉与股骨颈系统治疗的PauwelsⅢ型青壮年股骨颈骨折患者21例,其中9例采用3枚倒三角形空心螺钉+1枚垂直骨折线的横行拉力螺钉治疗(3+1空心螺钉组),12例患者采用股骨颈系统固定治疗(股骨颈系统组)。在手术时间、术中失血量、手术切口总长度、术中透视次数,骨折愈合时间、肢体功能等方面对两种固定方式进行比较。结果与结论:①所有患者均获得随访,3+1空心螺钉组患者随访时间10-25个月,平均(17.44±4.30)个月;股骨颈系统组患者随访时间8-24个月,平均(15.58±4.68)个月。②在术中透视次数、术后3个月Harris评分方面,股骨颈系统组优于3+1枚空心螺钉组,差异有显著性意义(P<0.05);3+1枚空心螺钉组的术中失血量、切口总长度、股骨颈短缩距离优于股骨颈系统组,差异有显著性意义(P<0.05);两组患者的手术时间、骨折愈合时间、末次随访Harris评分方面差异均无显著性意义(P>0.05)。③提示3枚倒三角空心螺钉辅助横形拉力螺钉与股骨颈系统治疗青壮年PauwelsⅢ型股骨颈骨折均能取得良好的临床效果,股骨颈系统术中透视次数更少、早期整体稳定性更好,而3+1枚空心螺钉固定更微创、操作更便捷。两种固定方式均值得临床应用与推广,可结合临床实际情况进行选择。
BACKGROUND:Pauwels III femoral neck fracture is a typical unstable fracture characterized by high vertical shear force and high incidence of postoperative complications.At present,there are many fixation methods for Pauwels III fracture,and there is no clear conclusion as to which internal fixation is the best fixation method for Pauwels III femoral neck fracture in young adults.OBJECTIVE:To compare the clinical effect of three inverted triangle cannulated screws assisted transverse lag screws and femoral neck system in fixing Pauwels III femoral neck fractures of young adults.METHODS:From May 2021 to December 2022,21 young and middle-aged patients with Pauwels III femoral neck fracture were treated with three inverted triangle cannulated screws assisted by transverse lag screws and femoral neck system in Affiliated Hospital of Southwest Medical University.Of them,9 patients were treated with three inverted triangle cannulated screws and one transverse lag screws perpendicular to the fracture line as the 3+1 cannulated screw group and 12 patients were treated with femoral neck system as the femoral neck system group.The two fixation methods were compared in terms of operation time,intraoperative blood loss,total incision length,intraoperative fluoroscopy times,fracture healing time,and limb function.RESULTS AND CONCLUSION:(1)All patients were followed up.Patients in the 3+1 cannulated screw group were followed up for 10-25 months,with a mean of(17.44±4.30)months.The patients in the femoral neck system group were followed up for 8-24 months,with a mean of(15.58±4.68)months.(2)The intraoperative fluoroscopy times and Harris score at 3 months postoperatively in the femoral neck system group were better than those in the 3+1 cannulated screw group,and the difference was statistically significant(P<0.05).The intraoperative blood loss,total incision length,and femoral neck shortening distance in the 3+1 cannulated screw group were better than those in the femoral neck system group,and the differences were statistical
作者
沈师
许玉林
李宇洁
徐学鹏
向飞帆
叶俊武
卓乃强
Shen Shi;Xu Yulin;Li Yujie;Xu Xuepeng;Xiang Feifan;Ye Junwu;Zhuo Naiqiang(Department of Bone and Joint Surgery,Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2024年第33期5351-5356,共6页
Chinese Journal of Tissue Engineering Research
基金
西南医科大学课题(2019ZQN094),项目负责人:沈师
四川省自然科学基金(2022NSFSC1534),项目负责人:向飞帆。
关键词
股骨颈骨折
PauwelsⅢ型
股骨颈系统
倒三角空心螺钉
横形拉力螺钉
femoral neck fracture
Pauwels III
femoral neck system
inverted triangle cannulated screw
transverse lag screw 5356|中国组织工程研究|第28卷|第33期|2024年11月
