| 双螺钉系统与3枚空心加压螺钉治疗股骨颈骨折的比较研究 |
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投稿时间：2013-02-25
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| 作者 | Author | 单位 | Address | E-Mail |
| 章年年 |
ZHANG Nian-nian |
上虞市人民医院骨科, 浙江 上虞 312300 |
Department of Orthopaedics, Shangyu People's Hospital, Shangyu 312300, Zhejiang, China |
znn961149@163.com |
| 叶招明 |
YE Zhao-ming |
浙江大学医学院附属第二医院骨科, 浙江 杭州 310000 |
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| 朱仰义 |
ZHU Yang-yi |
上虞市人民医院骨科, 浙江 上虞 312300 |
Department of Orthopaedics, Shangyu People's Hospital, Shangyu 312300, Zhejiang, China |
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| 任伟峰 |
REN Wei-feng |
上虞市人民医院骨科, 浙江 上虞 312300 |
Department of Orthopaedics, Shangyu People's Hospital, Shangyu 312300, Zhejiang, China |
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| 期刊信息：《中国骨伤》2013年，第26卷，第7期，第565-571页 |
| DOI：10.3969/j.issn.1003-0034.2013.07.009 |
| 基金项目: |
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中文摘要:
目的: 比较双螺钉系统与3枚空心加压螺钉内固定治疗股骨颈骨折的疗效。
方法: 对2007年1月至2009年6月收治的67例股骨颈骨折患者的临床资料进行回顾性分析,男38例,女29例;年龄31～71岁,平均50.6岁;左侧41例,右侧26例。根据不同内固定方式分为两组,双螺钉系统组(A组)30例,男19例,女11例;空心加压螺钉组(B组)37例,男19例,女18例。按Pauwells角分型:Pauwells角≥50°空心加压螺钉组22例,双螺钉系统组16例;Pauwells角<50°空心加压螺钉组15例,双螺钉系统组14例。比较两组患者的住院时间、手术时间、术中出血量、下地时间、切口感染、术后并发症、骨折复位质量、内固定置入满意率、骨折不愈合发生率、股骨头缺血性坏死率、内固定失效率、髋关节功能评分(Harris评分).
结果: 67例患者术后均获得随访,时间30～59个月,平均42个月。从围手术期指标分析,两组患者在住院时间、术中出血量、下地时间、切口感染、术后内科并发症等方面差异无统计学意义(P >0.05),手术时间双螺钉系统组为(31.1±9.7) min;空心加压螺钉组为(40.4±12.7) min,差异有统计学意义(P<0.05).从术后评估及中远期并发症分析:在内固定置入满意率、骨折复位质量、骨折不愈合发生率、股骨头缺血性坏死率等方面差异无统计学意义(P>0.05);而在内固定失效率上,Pauwells≥50°的病例,双螺钉系统组未出现退钉、断钉、螺钉切割股骨头等失效病例,而空心加压螺钉组有2例出现退钉,2例出现螺钉切割股骨头,2例螺钉未完全进入股骨头,两组比较差异有统计学意义(P<0.05);在Pauwells<50°的病例,双螺钉系统组出现1例螺钉松动的失效病例,空心加压螺钉组有1例出现螺钉切割,两组比较差异无统计学意义(P>0.05),其中螺钉松动、退钉及切割股骨头的患者年龄都大于65岁。术后6、30个月两组Harris评分差异无统计学意义(P>0.05).
结论: 双螺钉系统内固定术治疗股骨颈骨折具有创伤小、操作简便、固定确实等优点。与传统的3枚空心加压螺钉固定比较,双螺钉系统组具有更少的手术时间,更少的内固定失败率,更高的患髋功能评分。特别对于Pauwells角≥50°的股骨颈骨折的患者有良好的疗效。 |
| 【关键词】股骨颈骨折 骨折固定术,内 病例对照研究 |
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| Case-control study on double screws system and compressed three canulated screws in treating femoral neck fractures |
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ABSTRACT
Objective: To compare the clinical effects of double screws system and compressed three canulated screws in treating femoral neck fractures.
Methods: From January 2007 to June 2009,the clinical data of 67 patients with femoral neck fractures underwent operation were retrospectively analyzed. There were 38 males and 29 females,aged from 31 to 71 years with an average of 50.6 years,left was in 41 cases and right was in 26 cases. The patients were divided into two groups (group A and B) based on the different fixation method. Of them,30 cases (group A,19 males and 11 females) were treated with double screws system and 37 cases (group B,19 males and 18 females) with compressed three canulated screws. In group A,Pauwells angle was more than or equal 50° in 16 cases and Pauwells angle less 50° in 14 cases;in group B,Pauwells angle was more than or equal 50° in 22 cases and Pauwells angle less 50° in 15 cases. Duration of hospitalization,operative time,intraoperative blood loss,postoperative time in bed,infection of incision,postoperative complication,quality of fracture reduction,position of internal fixation,incidence of non-union and femoral head necrosis,incidence of failure fixation,joint function (Harris score) were compared between two groups.
Results: All patients were followed up from 30 to 59 months with an average of 42 months. There was no significant differences in aspect of duration of hospitalization,infection of incision,intraoperative blood loss,walking time,postoperative complications between two groups (P >0.05). Operative time of group A[(31.1±9.7) min]was less than that of group B[(40.4±12.7)min](P<0.05). There was no significant differences in quality of fracture reduction,position of internal fixation,incidence of non-union and femoral head necrosis between two groups(P >0.05). In the patients with Pauwells angle more than or equal 50° in group A,there was no retreated screws,broken screws,screw cut-off from the femoral head;and in group B,retreated screws occurred in 2 cases,screw cut-off from the femoral head occurred in 2 cases,screws not completely getting in femoral head occurred in 2 cases;there was significant differences between two groups(P<0.05). The patients with Pauwells angle less 50° in group A,screw loosening occurred in one case;and in group B,screw retreating occurred in one cases;there was no significant differences between two groups(P >0.05). All patients who suffered from screw loosening,retreating or cut-off from the femoral head were more than 65 years old. There was no significant differences in the joint function between two groups at 6 and 30 months after operations(P >0.05).
Conclusion: Double screws system has advantages of minimal invasion,easy operation,reliable fixation in treatment of femoral neck fractures. Compared with the traditional compressed three canulated screws,double screws system has less fixation failure rate and higher hip function scoring. It has a good clinical effect especially for the patients with Pauwells angle more than or equal 50°。 |
| KEY WORDS Femoral neck fractures Fracture fixation,internal Case-control studies |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 章年年,叶招明,朱仰义,任伟峰.双螺钉系统与3枚空心加压螺钉治疗股骨颈骨折的比较研究[J].中国骨伤,2013,26(7):565~571 |
| 英文格式: | ZHANG Nian-nian,YE Zhao-ming,ZHU Yang-yi,REN Wei-feng.Case-control study on double screws system and compressed three canulated screws in treating femoral neck fractures[J].zhongguo gu shang / China J Orthop Trauma ,2013,26(7):565~571 |
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