摘要
目的比较股骨颈动力抗旋交叉钉系统(FNS)和三枚空心螺钉治疗不稳定股骨颈骨折的早期临床疗效。方法回顾性分析2019年1月至2020年6月于南京医科大学附属苏州医院关节外科接受FNS或空心螺钉内固定治疗的81例PauwelsⅢ型股骨颈骨折患者。纳入标准:新鲜单侧闭合性股骨颈骨折,资料完整,排除标准为存在严重疾病、病理性骨折和不能配合的患者。采用配对设计研究,按照性别相同、年龄±3岁,身体质量指数±2 kg/m^(2),麻醉分级相同,术前血红蛋白±10 g/L,以1∶1的比例匹配。FNS组26例,空心螺钉组26例为对照。采用配对t检验和确切概率法比较两组患者手术时间,术中出血量,住院时间,住院费用,术后视觉模拟评分,脱拐行走时间,髋关节功能Harris评分,欧洲5维度健康量表(EQ-5D)和并发症发生率。结果共成功匹配26对,所有患者平均年龄为(56±7)岁。所有患者术后复查摄片均复位满意。FNS组患者平均随访时间为(14.5±2.2)个月,空心螺钉组为(19.2±3.5)月。FNS组患者术后VAS评分为(3.2±1.1)分,空心螺钉组为(3.8±1.0)分,FNS组患者VAS评分更低(t=0.246,P=0.021);FNS组患者脱拐行走时间为(5.3±1.5)月,空心螺钉组为(6.0±1.4)月,FNS组患者脱拐行走时间更早(t=4.215,P<0.001);FNS组患者术后1年随访时Harris为(86.4±6.6)分,空心螺钉组患者为(81.9±7.6)分,FNS组患者的Harris评分更高(t=2.486,P=0.020)。FNS组患者术后1年随访时EQ-5D评分为(71.5±11.3)分,空心螺钉组患者为(63.9±6.8)分,FNS组患者的EQ-5D评分更高(t=3.076,P=0.005)。FNS组患者术中出血量(85.4±41.2)ml,空心螺钉组(29.4±8.3)ml,接受FNS的患者术中出血更多(t=6.439,P<0.001);FNS组住院费用(46.9±2.4)千元高于空心螺钉组的(15.7±1.8)千元(t=47.866,P<0.001)。FNS组出现2例并发症,而空心螺钉组出现5例,两组并发症发生率差异无统计学意义(P=0.354)。两组患者的手术时间和住院时间差异无统计学意义(P>0.05)。结论针对不稳定股骨颈骨折,相较于3枚空心螺钉内固定,FNS近期疗效肯定,使它成为一种全新的治疗不稳定股骨颈骨折的内固定方案,为临床治疗提供了新选择。
Objective To compare the early clinical effects of femoral neck system(FNS)and three cannulated screws in the treatment of patients with unstable femoral neck fractures.Methods A retrospective analysis was conducted on 81 patients who received FNS or cannulated screws internal fixation for Pauwels typeⅢfemoral neck fracture in depertment of jont surgeny of the Affiliated Suzhou Hospital of Nanjing Medical University from January 2019 to June 2020.Inclusion criteria:fresh unilateral closed femoral neck fractures with complete data.Exclusion criteria:severe diseases,pathological fractures and uncooperative patients.A pair-matched clinical research was performed.Matching requirements were as follows:the same gender,the similar age,the similar body mass index,the same American Society of Anesthesiologists grade and the similar hemoglobin.The patients who received FNS were the FNS group(26 cases)and the patients received cannulated screws were the cannulated screw group as control(26 cases).The operation time,intraoperative blood loss,hospital stay,hospitalization cost,postoperative visual analogue scale(VAS),time walking without crutches,Harris score,Europe quality of life-five dimensions questionnaire(EQ-5D)and complication rate were compared by paired t test and exact probability method between the two groups.Results A total of 26 pairs were successfully matched,with an average age of(56±7)years.Postoperative re-examination of radiographs showed satisfactory reduction in all the patients.The FNS group were followed up for(14.5±2.2)months and the cannulated screw group were followed up for(19.2±3.5)months.VAS score was lower in the FNS group(3.2±1.1)than in the cannulated screw group(3.8±1.0)(t=2.461,P=0.021).The FNS group took(5.3±1.5)months recovering to walking without crutches,which was earlier than the cannulated screw group(6.0±1.4)months(t=4.215,P<0.001).The Harris scores were higher in the FNS group(86.4±6.6)than in the cannulated screw group(81.9±7.6 scores)(t=2.486,P=0.020).The postoperative EQ-5D score was higher in the FNS group(71.5±11.3)than that in the cannulated screw group(63.9±6.8)(t=3.076,P=0.005).The FNS group showed more intraoperative blood loss(85.4±41.2)ml than the cannulated screw group(29.4±8.3)ml(t=6.439,P<0.001).The FNS group spent more on hospitalization costs(46.9±2.4)thousand-yuan than the cannulated screw group(15.7±1.8)thousand-yuan(t=47.866,P<0.001).There was no significant difference in the incidence of complications between the FNS group(2/26)and the cannulated screw group(5/26)(P=0.354).There was no statistically significant difference in operation time and hospital stay between two group(P>0.05).Conclusion For unstable femoral neck fracture,FNS has satisfactory short-time clinical efficacy,the excellent biomechanical performance and clinical efficacy of FNS makes it a new choice for the treatment of unstable femoral neck fracture.
作者
周晓强
孙超
李志强
徐人杰
佘远时
张向鑫
陈广祥
虞宵
Zhou Xiaoqiang;Sun Chao;Li Zhiqiang;Xu Renjie;She Yuanshi;Zhang Xiangxin;Chen Guangxiang;Yu Xiao(Department of Joint Surgery,The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Gusu School,Nanjing Medical University,Suzhou 215000,China)
出处
《中华关节外科杂志（电子版）》
CAS
CSCD
2022年第6期670-676,共7页
Chinese Journal of Joint Surgery(Electronic Edition)
基金
南京医科大学姑苏学院青年骨干科学研究培育专项(GSKY20220521)
江苏省卫健委医学科研项目重点项目(K2019010)
关键词
股骨颈骨折
骨折固定术
内
内固定器
骨螺丝
Femoral neck fractures
Fracture fixation,internal
Internal fixators
Bone screws
作者简介
通信作者:虞宵,Email:yuxiao-szmh@139.com
