摘要
[目的]比较多枚空心螺钉与动力髋螺钉(DHS,Dynamic Hip screw)内固定治疗股骨颈骨折的疗效。[方法]2013年2月~2016年3月共收治67例股骨颈新鲜骨折患者,58例获得随访。其中男24例,女34例;年龄22~65岁,平均43.2岁。多枚空心螺钉固定35例,DHS固定23例。根据骨折Garden分型,其中空心钉组GardenⅠ型9例,Ⅱ型12例,Ⅲ型10例,Ⅳ型4例;DHS组Ⅰ型2例,Ⅱ型4例,Ⅲ型11例,Ⅳ型6例。记录手术时间,术中出血量,输血情况,二次手术,并发症发生率,髋关节功能Harris评分。[结果]平均随访25.6个月,两组术后切口均一期愈合。手术时间空心钉组平均(39.57±12.96)min,DHS组平均(48.06±13.04)min,出血量空心钉组平均(20.86±25.2)ml,DHS组平均(65.43±37.9)ml,差异均有统计学意义(P<0.05)。输血例数空心钉组5例,DHS组3例,差异无统计学意义(P>0.05)。空心钉组骨折愈合时间平均(14.11±6.34)周,DHS组(9.39±1.95)周,差异有统计学意义(P<0.05)。末次随访空心钉组和DHS组Harris评分分别为(91.2±11.16)分和(95.39±3.07)分,差异无统计学意义。空心钉组有3例(8.57%)股骨头缺血坏死,1例(2.86%)进行髋关节置换。DHS未发现股骨头缺血坏死病例。空心钉组18例(51.43%)存在股骨颈短缩,其中14例(40%)因螺钉突出不适要求行内固定取出;DHS组6例(26.09%)存在轻度股骨颈短缩,无因内固定物突出原因要求取出内固定者。[结论]空心钉和DHS治疗股骨颈骨折都可获得较高的骨折愈合率,DHS固定具有骨折愈合快,股骨颈短缩发生率低,再次手术率低的优点。
[Objective] To compare the clinical outcome of eannulated screw versus dynamic hip screw （DHS） for treatment of femoral neck fracture. [Methods] Between February 2013 and March 2016, 58 patients with femoral neck fraeture were surgi- cally treated in our hospital, including 34 temales and 24 males with an average age of 43.2 years ranged from 22 to 65 years. Of them, 35 patients received internal fixation with cannulated screws, while 23 patients with DHS. Operation lime, intraoperative blood loss, blood transfusion, complications and Harris hip score were compared between the two groups. [Results] The operation time and intraoperative blood loss in the eannulated screw group were significantly less than those in the DHS group （P〈 0.05）, but no a significant difference was noted between them in blood transfusion （P〉0.05）. No wound infection was found in any patient. All the patients were followed up fur an average of 25.6 months. The time of bone healing was （14.11 ±6.34）weeks in tire eannulated screw group, whereas （9.39±1.95） weeks in DHS group （P〈0.05）. At the latest follow up, Harris hip score pr,ved 91.2±11.16 in the cannulated screw group and 95.39±3.07 in the DHS group, without a significant difference between them （P〉 0.05）. Three patients （8.57%） of the eammlated screw group had femoral head necrosis, including 1 patient underwent total hip replacement, whereas no avascular necrosis of femoral head occurred in any patient of the DHS group at the latest latest follow up. In addition, 18 patienls with the cannulated screw suffered from considerable neck shortening, 14 of them needed secondary opera- tion to remove the implants because of the irritation of the protruded screws, whereas 6 patients with the DHS had mild neck shortening without implant removal needed. [Conclusions] Both eannulated screw and DHS fixation are proper treal- ment for femoral neck fracture with high healing rate. However, DHS fixation is ruore reeommendable with advantages of faster bone healing, less neek shortening and less need for reoperation.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2017年第22期2038-2041,共4页
Orthopedic Journal of China
关键词
股骨颈骨折
空心螺钉
动力髋螺钉
femoral neck fracture, cannulated screw, dynamic hip screw
