摘要
目的 探讨股骨近端锁定接骨板(proximal femoral locking compression plate,PFLCP)与半螺纹空心钉治疗中青年 Pauwels Ⅲ 型股骨颈骨折的疗效.方法 选取 2011 年 1 月至 2021 年 12 月,我科收治的Pauwels Ⅲ 型股骨颈骨折患者 62 例,其中男 42 例,女 20 例.按随机数字表法分为 A、B 两组,A 组为 3 枚半螺纹空心螺钉固定(n=31),其中男 20 例、女 11 例;B 组为 PFLCP 固定(n=31),男 22 例,女 9 例.术后进行 12 个月随访,观察记录股骨颈骨折内固定术后愈后情况.对比 A、B 组患者手术操作时间、骨折不愈合发生率,分析骨折复位质量并测量患侧股骨颈短缩等数据;进行髋关节 Harris 评分.结果 两组手术时间和股骨头坏死率差异无统计学意义(P>0.05).螺钉松动共 10 例,A 组 9 例,B 组 1 例,差异有统计学意义(P=0.010);股骨颈短缩共 9 例,A 组 8 例,B 组 1 例,差异有统计学意义(P=0.012);股骨颈骨折不愈合共 11 例,A 组 9 例,B 组 2 例,差异有统计学意义(P=0.018);术后 12 个月 Harris 评分,A 组平均(60.37±4.82)分,B 组平均(75.57±9.13)分,差异有统计学意义(P=0.031).结论 相比于使用 3 枚半螺纹空心螺钉,使用 PFLCP可显著提高骨折改善治疗效果,可为 Pauwels Ⅲ型股骨颈骨折治疗提供新的选择.
Abstract
Objective To investigate the curative effect of proximal femoral locking compression plate and cannulated screws in the treatment of Pauwels Ⅲ femoral neck fracture in young and middle-aged adults.Methods From January 2011 to December 2021,62 patients with Pauwels Ⅲ femoral neck fracture were enrolled,including 42 males and 20 females.All were divided into 2 groups according to the random number list method.Group A(general group):fracture fixation by three half-thread cannulated screws;n=31;20 males and 11 females.Group B(control group):fracture fixation by proximal femoral locking compression plate;n=31;22 males and 9 females.All patients were followed up for 12 months to observe the prognosis.The operation time and fracture nonunion rate were compared in both groups.The reduction quality of the fracture was analyzed and the femoral neck shortening of the affected side was measured.Harris score of the hip joint was assessed.Results There was no significant difference in operation time between the two groups(P>0.05).There was no significant difference in femoral head necrosis rate between the two groups(P>0.05).There were 10 cases of screw loosening,9 cases in Group A and 1 case in Group B with statistically significant difference(P=0.010).There were 9 cases of femoral neck shortening,8 cases in Group A and 1 case in Group B with statistically significant difference(P=0.012).There were 11 cases of femoral neck fracture nonunion,9 cases in Group A and 2 cases in Group B with statistically significant difference(P=0.018).Effects were evaluated in both Group A and B 12 months after the operation,and the average Harris hip scores were(60.37±4.82)and(75.57±9.13)with statistically significant difference(P=0.031).Conclusions Compared with fracture fixation by three half-thread cannulated screws,fracture fixation by proximal femoral locking compression plate can improve the treatment effects,providing new options for the treatment of Pauwels Ⅲ femoral neck fracture.
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