Department of Traumatology, Tianjin Hospital, Tianjin, China.
Department of Orthopaedics, Tianjin Hospital, Tianjin, China.
Orthop Surg. 2019 Aug;11(4):595-603. doi: 10.1111/os.12503. Epub 2019 Jul 23.
To compare the clinical therapeutic effect of transverse cancellous lag screw (TCLS) fixations and ordinary cannulated screw (OCS) fixations for vertical femoral neck fractures.
A total of 62 eligible patients with an average age of 56.2 years (range, 19-45 years; 40 male and 22 female) with Pauwels' type III femoral neck fractures were recruited in our study from January 2016 to December 2017. Among the patients, 30 underwent TCLS fixation (TCLS group), and the others were treated with OCS fixation (OCS group). The baseline data, perioperative outcomes (operative time, intra-operative blood loss, reduction quality, and hospital time), postoperative outcomes evaluated by a variety of scales including visual analogue scale (VAS) score, EuroQol five dimensions questionnaire (EQ-5D) and Harris hip scores (HHS), and complications (nonunion, femoral head necrosis, femoral neck shortening, and failure of fixation) of the two groups were recorded to compare at 12-month follow-up.
The mean follow-up time of included patients was 13.4 ± 1.6 months in the TCLS group and 13.7 ± 0.9 months in the OCS group. There was no statistically significant difference in the baseline data as well as perioperative outcomes, including operative time, intra-operative blood loss, the hemoglobin difference before and after treatment, quality of reduction, and hospital time between two groups. Likewise, the VAS score, the EQ-5D score, and complications rates including nonunion and femoral head necrosis had no distinct difference in two groups. However, HHS in the TCLS group were superior to those in the OCS group at 12-month follow-up, and the femoral neck shortening rate was prominently reduced in the TCLS group when compared with the OCS group.
Treating vertical femoral neck fractures with the TCLS technique could significantly improve hip functional recovery and reduce the postoperative femoral neck shortening rate. The present study provides novel insight for the treatment of vertical femoral neck fractures.
比较横向松质骨拉力螺钉（TCLS）固定与普通空心螺钉（OCS）固定治疗垂直型股骨颈骨折的临床疗效。
回顾性分析 2016 年 1 月至 2017 年 12 月我院收治的 62 例 Pauwels Ⅲ型股骨颈骨折患者的临床资料，根据内固定方式不同分为 TCLS 组（30 例）和 OCS 组（32 例）。比较两组患者的一般资料、围手术期指标（手术时间、术中出血量、复位质量、住院时间）、术后不同时间点（1、3、6、12 个月）疼痛视觉模拟评分（VAS）、欧洲五维健康量表（EQ-5D）评分和 Harris 髋关节评分（HHS）、并发症（骨不连、股骨头坏死、股骨颈短缩、内固定失败）发生情况。
两组患者均获得随访，随访时间 13.4~16.0 个月，平均 13.4±1.6 个月。两组患者的一般资料及围手术期指标（手术时间、术中出血量、术后血红蛋白差值、复位质量、住院时间）比较，差异均无统计学意义（P＞0.05）。两组患者术后 1、3、6、12 个月 VAS 评分、EQ-5D 评分及并发症发生率比较，差异均无统计学意义（P＞0.05）。末次随访时，TCLS 组 HHS 评分高于 OCS 组，股骨颈短缩发生率低于 OCS 组，差异有统计学意义（P＜0.05）。
与 OCS 固定相比，采用 TCLS 治疗垂直型股骨颈骨折可明显改善髋关节功能，降低术后股骨颈短缩发生率。
