空心钉与股骨颈动力交叉钉系统治疗Pauwels Ⅱ～Ⅲ型股骨颈骨折的疗效比较

段霄; 张智勇; 陈宗文; 徐磊

doi:10.11659/jjssx.08E022141

您当前的位置：

首页 >

文章列表页 >

空心钉与股骨颈动力交叉钉系统治疗Pauwels Ⅱ～Ⅲ型股骨颈骨折的疗效比较

临床研究 | 更新时间：2023-04-24

- 空心钉与股骨颈动力交叉钉系统治疗Pauwels Ⅱ～Ⅲ型股骨颈骨折的疗效比较
- Comparison of efficacy of cannulated compression screws and femoral neck system in treatment of Pauwels type Ⅱ and Ⅲ femoral neck fractures
- 局解手术学杂志 2023年32卷第4期页码：340-345
- 作者机构：
  
  淮北矿工总医院骨科,安徽淮北 235000
- 作者简介：
  
  段霄，E-mail：dd151825119@163.com
- 基金信息：
- DOI：10.11659/jjssx.08E022141
  中图分类号： R687.3
- 纸质出版日期：2023-04-25，
  
  收稿日期：2022-08-25，
扫描看全文
段霄,张智勇,陈宗文等.空心钉与股骨颈动力交叉钉系统治疗Pauwels Ⅱ～Ⅲ型股骨颈骨折的疗效比较[J].局解手术学杂志,2023,32(04):340-345.

DUAN Xiao,ZHANG Zhi-yong,CHEN Zong-wen,et al.Comparison of efficacy of cannulated compression screws and femoral neck system in treatment of Pauwels type Ⅱ and Ⅲ femoral neck fractures[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(04):340-345.
段霄,张智勇,陈宗文等.空心钉与股骨颈动力交叉钉系统治疗Pauwels Ⅱ～Ⅲ型股骨颈骨折的疗效比较[J].局解手术学杂志,2023,32(04):340-345. DOI： 10.11659/jjssx.08E022141.

DUAN Xiao,ZHANG Zhi-yong,CHEN Zong-wen,et al.Comparison of efficacy of cannulated compression screws and femoral neck system in treatment of Pauwels type Ⅱ and Ⅲ femoral neck fractures[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(04):340-345. DOI： 10.11659/jjssx.08E022141.

摘要

目的

探究空心钉（CCS）内固定与股骨颈动力交叉钉系统（FNS）治疗Pauwels Ⅱ~Ⅲ型股骨颈骨折的疗效。

方法

选取于本院就诊的84例Pauwels Ⅱ~Ⅲ型后侧壁粉碎股骨颈骨折患者为研究对象。根据治疗方式不同分为CCS组（

=42）和FNS组（

=42）。比较2组患者围术期指标、随访结果、疼痛情况、Oswestry功能障碍指数（ODI）、日常生活能力、治疗前后炎症指标水平[白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）、降钙素原（PCT）水平]及术后12个月生活质量评分。采用随机行走模型评价2组患者炎症指标的改善情况。

结果

FNS组手术时间短于CCS组（

0.05），切口长度及术中出血量长/多于CCS组（

0.05）；2组患者住院时间、Garden力线指数及辅助复位情况比较差异无统计学意义（

0.05）。FNS组患者骨折愈合时间、术后部分及完全负重时间、股骨颈短缩长度及程度、颈干角变化、大腿外侧激惹症状发生率均短/小/低于CCS组，末次随访髋关节Harris评分高于CCS组（

0.05），2组患者股骨头坏死发生率无明显差异（

0.05）。治疗后，FNS组视觉模拟量表（VAS）评分、ODI评分、IL-6、TNF-α、CRP、PCT水平均低于CCS组（

0.05），日常生活能力评分、术后12个月生活质量评分高于CCS组（

0.05）。随机行走模型结果显示，FNS组患者炎症指标较CCS组改善显著（

0.05）。

结论

与CCS内固定治疗相比，FNS治疗Pauwels Ⅱ~Ⅲ型后侧壁粉碎股骨颈骨折的临床效果更好，可缩短手术时间及骨折愈合时间，减轻患者疼痛，缓解炎症反应等。

Abstract

Objective

To explore the clinical effect of cannulated compression screws （CCS） internal fixation and femoral neck system （FNS） in the treatment of Pauwels type Ⅱ and Ⅲ femoral neck fractures.

Methods

A total of 84 patients of Pauwels type Ⅱ or Ⅲ femoral neck fracture with posterior comminution treated in our hospital were selected as the research objects. According to different treatment methods， the patients were divided into CCS group （

=42） and FNS group （

=42）. The perioperative indicators，follow-up results，pain status，Oswestry disability index（ODI），ability of daily living，levels of inflammatory indicators ［interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， C-reactive protein （CRP）， procalcitonin （PCT）］ before and after treatment，and the quality of life score 12 months after operation were compared between the two groups.The random walk model was used to evaluate the improvement of inflammatory indicators in the two groups.

Results

The operation time of FNS group was shorter than that of CCS group（

0.05），the incision length and intraoperative blood loss of FNS group were longer or more than those of CCS group （

0.05）.There was no significant difference in hospital stay， Garden index and assisted reduction between the two groups（

0.05）. The fracture healing time，partial and complete weight bearing time after operation，length and degree of femoral neck shortening，neck shaft angle change，and incidence of lateral thigh irritation in FNS group were all shorter/less/lower than those in CCS group， and Harris score of hip joint was higher than that in CCS group at the last follow-up （

0.05）， while there was no significant difference in the incidence of femoral head necrosis between the two groups（

0.05）. After treatment， the visual analogue scale（VAS） score， ODI score，levels of IL-6， TNF-α， CRP and PCT in FNS group were lower than those in CCS group（

0.05）， and the ability of daily living score and quality of life score 12 months after surgery were higher than those in CCS group （

0.05）. The inflammatory indicators of patients in FNS group were significantly improved compared with those in CCS group by random walk model（

0.05）.

Conclusion

Compared with CCS internal fixation，FNS has a good clinical effect in the treatment of Pauwels type Ⅱ and Ⅲ femoral neck fractures with posterior comminution，which can shorten the operation time and fracture healing time，relieve the pain and the inflammation response of patients.

关键词

空心钉内固定股骨颈动力交叉钉系统股骨颈骨折复位

Keywords

cannulated compression screwsinternal fixationfemoral neck systemfemoral neck fracturereduction

references

Sano K，Homma Y，Shirogane Y，et al.Acetabular morphological variation in Asian patients with femoral neck fracture：a three-dimensional CT-based study［J］.Injury，2022，53（8）：2823-2831.doi：10.1016/j.injury.2022.06.023http://dx.doi.org/10.1016/j.injury.2022.06.023.

Fan Z，Huang Y，Su H，et al.How to choose the suitable FNS specification in young patients with femoral neck fracture：a finite element analysis［J］.Injury，2021，52（8）：2116-2125.doi：10.1016/j.injury. 2021.05.043http://dx.doi.org/10.1016/j.injury.2021.05.043.

Yuan KX，Yang F，Fu K，et al.Internal fixation using fully threaded cannulated compression screws for fresh femoral neck fractures in adults［J］.J Orthop Surg Res，2022，17（1）：108.doi：10.1186/s13018-022-03005-8http://dx.doi.org/10.1186/s13018-022-03005-8.

Tang Y，Zhang Z，Wang L，et al.Femoral neck system versus inverted cannulated cancellous screw for the treatment of femoral neck fractures in adults：a preliminary comparative study［J］.J Orthop Surg Res，2021，16（1）：504.doi：10.1186/s13018-021-02659-0http://dx.doi.org/10.1186/s13018-021-02659-0.

Chu K，Cheng G，Yu GZ，et al.Inconsistency of bone mineral density between femoral head and proximal femur after femoral neck fracture surgery indicates great possibility of femoral head necrosis［J］.Orthopedics，2020，44（2）：1-6.doi：10.3928/01477447-20201216-06http://dx.doi.org/10.3928/01477447-20201216-06.

Teng Y，Zhang Y，Guo C.Finite element analysis of femoral neck system in the treatment of Pauwels type Ⅲfemoral neck fracture［J］.Medicine，2022，101（28）：e29450.doi：10.1097/MD.0000000000029450http://dx.doi.org/10.1097/MD.0000000000029450.

He C，Lu Y，Wang Q，et al.Comparison of the clinical efficacy of a femoral neck system versus cannulated screws in the treatment of femoral neck fracture in young adults［J］.BMC Musculoskelet Dis，2021，22（1）：994.doi：10.1186/s12891-021-04888-0http://dx.doi.org/10.1186/s12891-021-04888-0.

Hu H，Cheng J，Feng M，et al.Clinical outcome of femoral neck system versus cannulated compression screws for fixation of femoral neck fracture in younger patients.［J］.J Orthop Surg Res，2021，16（1）：370.doi： 10.1186/s13018-021-02517-zhttp://dx.doi.org/10.1186/s13018-021-02517-z.

Steffensmeier A，Shah N，Archdeacon M，et al.Clinical and biomechanical effects of femoral neck buttress plate used for vertical femoral neck fractures［J］.Injury，2022，53（3）：1137-1143.doi：10.1016/j.injury.2021.12.004http://dx.doi.org/10.1016/j.injury.2021.12.004.

Marchand LS，Butler B，McKegg P，et al.Fixed angle device comparison in young femoral neck fractures：dynamic hip screw vs dynamic helical hip system［J］.Injury，2022，53（2）：590-595.doi：10.1016/j.injury.2021.11.016http://dx.doi.org/10.1016/j.injury.2021.11.016.

朱　轶，刘　苏，张金坤，等.股骨颈动力交叉钉系统与3枚空心钉内固定治疗股骨颈骨折的短期疗效比较［J］.中国骨与关节损伤杂志，2022，37（6）：605-608.doi：10.7531/j.issn.1672-9935.2022.06.011http://dx.doi.org/10.7531/j.issn.1672-9935.2022.06.011.

Bliven E，Sandriesser S，Augat P，et al.Biomechanical evaluation of locked plating fixation for unstable femoral neck fractures［J］.Bone Joint Res，2020，9（6）：314-321.doi：10.1302/2046-3758.96.BJR-2019-0331.R1http://dx.doi.org/10.1302/2046-3758.96.BJR-2019-0331.R1.

Schopper C，Zderic I，Menze J，et al.Higher stability and more predictive fixation with the femoral neck system versus Hansson pins in femoral neck fractures Pauwels Ⅱ［J］.J Orthop Translat，2020，24：88-95.doi：10.1016/j.jot.2020.06.002http://dx.doi.org/10.1016/j.jot.2020.06.002.

许新忠，常　菁，余水生，等.股骨颈系统固定治疗股骨颈骨折的近期疗效分析［J］.中华创伤骨科杂志，2020，22（7）：624-627.doi：10.3760/cma.j.cn115530-20200618-00410http://dx.doi.org/10.3760/cma.j.cn115530-20200618-00410.

Moon JK，Lee JI，Hwang KT，et al.Biomechanical comparison of the femoral neck system and the dynamic hip screw in basicervical femoral neck fractures［J］.Sci Rep，2022，12（1）：7915.doi：10.1038/s41598-022-11914-1http://dx.doi.org/10.1038/s41598-022-11914-1.

Brattgjerd JE，Niratisairak S，Steen H，et al.Intermediate dynamic compression and decreased posterior tilt with interlocked pins in femoral neck fixation in synthetic bone［J］.J Biomech Eng，2021，143（7）：074502.doi：10.1115/1.4050282http://dx.doi.org/10.1115/1.4050282.

杨家赵，周雪锋，朱万博，等.股骨颈动力交叉钉系统与空心螺钉固定治疗青壮年股骨颈骨折的近期疗效比较［J］.中华创伤骨科杂志，2021，23（9）：761-768.doi：10.3760/cma.j.cn115530-20210205-00073http://dx.doi.org/10.3760/cma.j.cn115530-20210205-00073.

Shu DP，Xiao YP，Bei MJ，et al.Dynamic compression locking system versus multiple camiulated compression screw for the treatment of femoral neck fractures：a comparative study［J］.BMC Musculoskelel Disord，2020，21（1）：230.doi：10.1186/s12891-020-03259-5http://dx.doi.org/10.1186/s12891-020-03259-5.

Song JH，Kim J，Oh S.Internal fixation of Pauwels type-3 undisplaced-incomplete insufficiency femoral neck fractures with cephalomedullary nails［J］.Hip Pelvis，2020，32（2）：105-111.doi：10.5371/hp. 2020.32.2.105http://dx.doi.org/10.5371/hp.2020.32.2.105.

熊　巍，易　敏，龙　成，等.股骨颈动力交叉钉系统与倒三角形空心螺钉固定治疗成人股骨颈骨折的疗效比较［J］.中华创伤骨科杂志，2021，23（9）：748-753.doi：10.3760/cma.j.cn115530-20210822-00388http://dx.doi.org/10.3760/cma.j.cn115530-20210822-00388.

Roytman GR，Ramji AF，Beitler B，et al.Accuracy of guide wire placement for femoral neck stabilization using 3D printed drill guides［J］.3D Print Med，2022，8（1）：19.doi：10.1186/s41205-022-00146-8http://dx.doi.org/10.1186/s41205-022-00146-8.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

成人股骨颈骨折术后股骨头坏死的多因素分析

不同体位股骨近端防旋髓内钉内固定治疗老年不稳定型股骨粗隆间骨折的疗效

桡骨远端骨折内固定后背侧关节内骨块移位的列线图模型

经皮骨钩股骨近端防旋髓内钉内固定术治疗股骨粗隆间骨折的疗效及安全性

不同入路内固定治疗股骨干骨折的临床效果