Filipov Orlin, Stoffel Karl, Gueorguiev Boyko, Sommer Christoph
Vitosha Hospital, Simeonovsko shose str.108-B, 1700, Sofia, Bulgaria.
Cantonal Hospital Baselland, University Basel, Basel, Switzerland.
Arch Orthop Trauma Surg. 2017 Jun;137(6):779-788. doi: 10.1007/s00402-017-2689-8. Epub 2017 Apr 8.
Osteosynthesis of femoral neck fractures is related up to 46% rate of complications. The novel method of biplane double-supported screw fixation (BDSF; Filipov's method) offers better stability using three medially diverging cannulated screws with two of them buttressed on the calcar. Biomechanically, the most effective component is the distal screw placed at steeper angle and supported on a large area along the distal and posterior cortex of the femoral neck following its spiral anterior curve. Thereby, BDSF achieves the strongest possible distal-posterior cortical support for the fixation construct, which allows for immediate full weight-bearing. The aim of this study was to evaluate the outcomes from the first 5-year period of BDSF clinical application.
Subject of this retrospective study were 207 patients with displaced Garden III-IV femoral neck fractures treated with BDSF. Three 7.3-mm cannulated screws were laid in two medially diverging oblique planes. The distal and the middle screws were supported on the calcar. The distal screw had additional support on the posterior neck cortex.
The outcomes in 207 patients were analysed in 29.6 ± 16.8 months follow-up. Bone union occurred in 96.6% of the cases (males 97.6%, females 96.4%, P = 0.99). Rate of nonunion was 3.4%, including fixation failure (2.4%), pseudoarthrosis (0.5%) and nonunion with AVN (0.5%). Rate of AVN was 12.1% (males 4.8%, females 13.9%, P = 0.12). Modified Harris hip score was 86.2 ± 18.9 (range 10-100), with no significant difference between genders, P = 0.07. Older patients were admitted with significantly more comorbidities (P = 0.001), and on follow-up they were significantly less mobile (P = 0.005) and had significantly more difficulties to put socks and shoes on (P < 0.001).
By providing additional cortical support, the novel BDSF method enhances femoral neck fracture fixation strength.
股骨颈骨折的骨接合术并发症发生率高达46%。新型双平面双支撑螺钉固定法（BDSF；菲利波夫法）使用三根向内侧发散的空心螺钉，其中两根支撑于股骨矩，能提供更好的稳定性。从生物力学角度来看，最有效的部件是角度更陡的远端螺钉，它沿着股骨颈的螺旋前曲线，在股骨颈远端和后侧皮质的大面积区域得到支撑。由此，BDSF为固定结构提供了尽可能强的远端-后侧皮质支撑，从而允许立即完全负重。本研究的目的是评估BDSF临床应用首个5年期的结果。
本回顾性研究的对象为207例采用BDSF治疗的Garden III-IV型移位股骨颈骨折患者。三根7.3毫米的空心螺钉置于两个向内侧发散的斜平面。远端和中间的螺钉支撑于股骨矩。远端螺钉在颈后侧皮质还有额外支撑。
在平均29.6±16.8个月的随访期内分析了207例患者的结果。骨愈合发生在96.6%的病例中（男性97.6%，女性96.4%，P = 0.99）。不愈合率为3.4%，包括固定失败（2.4%）、假关节（0.5%）和伴有股骨头缺血性坏死（AVN）的不愈合（0.5%）。AVN发生率为12.1%（男性4.8%，女性13.9%，P = 0.12）。改良Harris髋关节评分86.2±18.9（范围10 - 100），性别间无显著差异，P = 0.07。老年患者合并症明显更多（P = 0.001），随访时活动能力明显更差（P = 0.005），穿袜子和鞋子时困难明显更多（P < 0.001）。
通过提供额外的皮质支撑，新型BDSF方法增强了股骨颈骨折的固定强度。
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