Weil Yoram A, Qawasmi Feras, Liebergall Meir, Mosheiff Rami, Khoury Amal
Orthopaedic Trauma Service, Department of Orthopedics, Hadassah Hebrew University Hospital, POB 12000, 91120, Jerusalem, Israel.
Arch Orthop Trauma Surg. 2018 May;138(5):661-667. doi: 10.1007/s00402-018-2896-y. Epub 2018 Feb 9.
Femoral neck fractures (FNF) are becoming increasingly common as population ages. Nondisplaced fractures are commonly treated by cancellous, parallel placed, partially threaded cannulated screws (PTS). This allows controlled fracture impaction. However, sliding implants can lead to femoral neck shortening (FNS) that has been shown to be correlated with reduced quality of life and impaired gait pattern. Recently, in our institution we have changed the fixation of FNF to fully threaded screws (FTS) with or without an additional partially threaded screw in order to minimize this phenomenon. The aim of this study was to compare the FNS in patients treated with FTS as compared with our historical controls treated with PTS.
Between 2014 and 2016, 38 patients with FNF were treated with FTS. Out of the 38, 24 were available for radiographic follow-up. 41 patients treated previously with PTS were available as a control group. Radiographic analysis was performed to assess the FNF in three vectors: Horizontal (X), Vertical (Y) and overall (Z) according to the neck-shaft angle.
Time for admission to surgery was longer in the PTS group (p = 0.04). Patient demographics and major complication rates were similar in the two patient groups. Average FNS in the X axis was significantly smaller in the FTS group than in the PTS group (2.8 ± 3.6 vs 7.6 ± 4.2 mm, p < 0.01) as well as the Y axis (1.2 ± 2.6 vs 4.9 ± 4.2 mm, p < 0.01) and thus also decreased overall Z shortening (2.3 ± 3.5 vs 6.23 ± 4.5 mm, p < 0.01). There was a tendency towards a more valgus reduction in the PTS (137° vs 134°, p = 0.08). There was a significantly smaller number of FTS patients with moderate (5-10 mm) or severe (> 10 mm) FNS. Screw pull-out > 5 mm occurred in 17/41 patients in the PTS but none in the FTS group (p < 0.01).
This study proves that use of FTS improves the radiographic results following FNF fixation using cannulated screws.
随着人口老龄化，股骨颈骨折（FNF）越来越常见。无移位骨折通常采用松质骨、平行放置、部分螺纹空心钉（PTS）治疗。这允许进行可控的骨折嵌插。然而，滑动植入物可导致股骨颈缩短（FNS），已证明这与生活质量下降和步态模式受损相关。最近，在我们机构，我们已将FNF的固定方式改为全螺纹螺钉（FTS），可使用或不使用额外的部分螺纹螺钉，以尽量减少这种现象。本研究的目的是比较FTS治疗患者与我们历史上PTS治疗对照组患者的FNS情况。
2014年至2016年期间，38例FNF患者接受了FTS治疗。38例患者中，24例可进行影像学随访。41例先前接受PTS治疗的患者作为对照组。根据颈干角，进行影像学分析以评估三个方向的FNF：水平（X）、垂直（Y）和总体（Z）。
PTS组手术入院时间更长（p = 0.04）。两组患者的人口统计学特征和主要并发症发生率相似。FTS组X轴的平均FNS明显小于PTS组（2.8±3.6 vs 7.6±4.2 mm，p < 0.01），Y轴也是如此（1.2±2.6 vs 4.9±4.2 mm，p < 0.01），因此总体Z轴缩短也减少（2.3±3.5 vs 6.23±4.5 mm，p < 0.01）。PTS组有更倾向于外翻复位的趋势（137° vs 134°，p = 0.08）。中度（5 - 10 mm）或重度（> 10 mm）FNS的FTS患者数量明显更少。PTS组41例患者中有17例发生螺钉拔出> 5 mm，而FTS组无1例（p < 0.01）。
本研究证明，使用FTS可改善空心钉固定FNF后的影像学结果。
