Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
Injury. 2020 Apr;51(4):1031-1037. doi: 10.1016/j.injury.2020.01.032. Epub 2020 Jan 24.
Osteosynthesis is recommended for Garden I and II femoral neck fracture treatment using parallel partially threaded cannulated screws. Postoperatively, excessive femoral neck shortening (FNS) and posterior tilt of the femoral neck (PTFN) are frequently encountered and are correlated with impaired quality of life and clinical outcomes. We hypothesized that stabilization by parallel partially threaded cannulated screws replacing a posterior partially threaded screw with a fully threaded positioning screw would improve fracture healing without further FNS and PTFN in femoral neck fractures.
We retrospectively reviewed Garden I and II femoral neck fractures treated by in situ fixation using parallel cannulated screws at our institution between January 2010 and November 2018. Patients with the applicable fractures were divided according to the utilization of posterior fully threaded screws: patients with partially threaded screws were included in Group C and those with posterior fully threaded screws were included in Group P. Intergroup comparisons were performed based on radiographic measurements that assessed the shortening in two vectors (the horizontal and vertical axes), FNS, and subsequent PTFN.
No significant intergroup difference was found in demographics and fracture characteristics, except in the follow-up duration. The mean FNS and shortening in both vectors were significantly smaller in Group P than in Group C (FNS, 5.02 ± 1.31 vs. 8.84 ± 3.48 mm, p < 0.001; horizontal axis, 4.07 ± 1.06 vs. 6.18 ± 2.77 mm, p < 0.001; and vertical axis, 2.55 ± 1.68 vs. 5.74 ± 3.41 mm, p < 0.001). The mean subsequent PTFN was significantly smaller in Group P (2.21 ± 2.99 vs. 7.56 ± 6.20 mm, p < 0.001). A significantly smaller number of patients in Group P had moderate (5-10 mm) or severe (>10 mm) FNS and moderate (5-10°) or severe (>10°) subsequent PTFN.
Parallel cannulated screws replacing a posterior partially threaded screw with a fully threaded positioning screw as a length- and angle-stable construct for Garden I or II femoral neck fracture fixation can prevent femoral neck collapse in both the coronal and axial planes.
对于 Garden I 和 II 型股骨颈骨折，建议使用平行部分螺纹空心螺钉进行骨 内固定。术后，股骨颈缩短（FNS）和股骨颈后倾（PTFN）过多的情况经常出现，并与生活质量和临床结果受损相关。我们假设，使用平行部分螺纹空心螺钉代替后部分螺纹螺钉的全螺纹定位螺钉进行固定，将改善骨折愈合，而不会导致股骨颈骨折的进一步 FNS 和 PTFN。
我们回顾性分析了 2010 年 1 月至 2018 年 11 月我院采用平行空心螺钉进行原位固定治疗的 Garden I 和 II 型股骨颈骨折患者。根据应用螺钉的不同，将具有适用骨折的患者分为两组：使用部分螺纹螺钉的患者纳入 C 组，使用后完全螺纹螺钉的患者纳入 P 组。根据评估两个向量（水平轴和垂直轴）、FNS 和随后的 PTFN 的缩短的影像学测量值进行组间比较。
除随访时间外，两组在人口统计学和骨折特征方面无显著差异。与 C 组相比，P 组的 FNS 和两个向量的缩短均明显更小（FNS，5.02±1.31 对 8.84±3.48mm，p<0.001；水平轴，4.07±1.06 对 6.18±2.77mm，p<0.001；垂直轴，2.55±1.68 对 5.74±3.41mm，p<0.001）。P 组的随后 PTFN 明显更小（2.21±2.99 对 7.56±6.20mm，p<0.001）。P 组中较少的患者出现中度（5-10mm）或重度（>10mm）FNS 和中度（5-10°）或重度（>10°）随后的 PTFN。
对于 Garden I 或 II 型股骨颈骨折固定，平行空心螺钉代替后部分螺纹螺钉的全螺纹定位螺钉作为长度和角度稳定的结构，可以防止冠状面和矢状面的股骨颈塌陷。
