Curative Effect of Open Reduction via DAA Combined with Greater Trochanter Anti-shear Screws in the Treatment of Unreducible Pauwels Type Ⅲ Femoral Neck Fracture
Objective To analyze the curative effect of open reduction via direct anterior approach(DAA)combined with greater trochanteric anti-shear screws in the treatment of unreducible pauwels type Ⅲ femoral neck fractures.Methods The clinical data of 60 patients with unreducible pauwels type Ⅲ femoral neck fractures admitted to Henan Luoyang Orthopedic Hospital(Henan Orthopedic Hospital)from April 2020 to June 2022 were retrospectively analyzed.According to the treatment method,they were divided into observation group(32 cases,treated with open reduction via DAA combined with greater trochanter anti-shear screws)and control group(28 cases,treated with closed reduction with 3 full-threaded cannulated compression screws).The general conditions of surgery,hip function(Harris Hip function score),fracture reduction quality(Garden index),bone metabolism indexes[N-terminal propeptide of type Ⅰ precollagen(PⅠ NP),bone specific alkaline phosphatase(BAP),β C-terminal cross-linked telopeptides of type Ⅰ collagen(β-CTX)],pain degree[McGill's pain questionnaire(McGill)],and the incidence of complications were compared between the two groups.Results The operation time of the observation group was longer than that of the control group,the length of incision was longer than that of the control group,and the intraoperative blood loss was more than that of the control group(P＜0.05).There was no significant difference in fracture healing time between the two groups(P＞0.05).Harris scores of both groups at 3,6 and 12 months after surgery were higher than those before surgery(P＜0.05).Harris scores of the observation group at 6 and 12 months after surgery were higher than those of the control group(P＜0.05).There was no significant difference in Garden classification between the two groups at 6 or 12 months after surgery(P＞0.05).Serum PINP and BAP in both groups increased while β-CTX and McGill scores decreased at 1 month after surgery(P＜0.05),without statistical difference between groups(P＞0.05).There was no difference in the incidence of femoral head necrosis between the two groups(P＞0.05).Conclusion For patients with unreducible pauwels type Ⅲ femoral neck fractures,the effect of open reduction via DAA combined with greater trochanter anti-shear screws is better.Although it may destroy the blood supply,it does not affect postoperative hip function recovery or increase the risk of complications.
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