Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China; Shanghai Trauma Emergency Center, Shanghai, 200072, China; Orthopedic Intelligent Minimally Invasive Diagnosis & Treatment Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
Injury. 2021 Aug;52(8):2384-2389. doi: 10.1016/j.injury.2021.02.048. Epub 2021 Feb 18.
Proximal femoral plating serves as a good alternative for the fixation of femoral neck fractures, but fixation loss still occurs. This study aimed to evaluate the effect of a hybrid configuration of short- and long-threaded cannulated screws in proximal femoral plating in terms of decreasing varus collapse of femoral neck fractures.
We retrospectively analyzed 86 patients with femoral neck fractures who were fixed by proximal femoral plating from January 2015 to June 2019. These patients were divided into two groups according to screw configuration: short- and long-threaded cannulated screws (SLTS, n = 38) and short-threaded cannulated screws (STS, n = 48). Radiological and clinical outcomes including screw withdraw, nonunion, avascular necrosis, caput-collum-diaphysis (CCD) angle, amount of femoral neck shortening (FNS), and Harris Hip Score (HHS) were compared between the groups.
Preoperative characteristics including age, gender, Garden type, duration of surgery, and reduction quality were not significantly different between the two groups (p > 0.05). Less decreased CCD angle was observed in the SLTS group (-0.4° (-1.4 - 1.8)) compared with that in the STS group (7.9° (6.3 - 11.0)) (p < 0.001). The SLTS group also presented with fewer amount of FNS (3.2 (2.7 - 3.8) mm vs. 5.1 (4.2 - 5.9) mm, p < 0.001). Bone union was achieved in all patients and no avascular necrosis was observed during the follow-up. The HHS was higher in the SLTS group (86.4 ± 5.1) than that in the STS group (81.5 ± 4.5) (p < 0.001).
The hybrid configuration of short- and long-threaded screws in proximal femoral plating offers better resistance against varus collapse and yields better functional outcomes in femoral neck fractures.
股骨近端接骨板是治疗股骨颈骨折的一种良好选择，但仍存在固定失败的情况。本研究旨在评估股骨颈骨折接骨板中短、长螺纹空心螺钉的混合构型在减少股骨颈骨折内翻塌陷方面的效果。
我们回顾性分析了 2015 年 1 月至 2019 年 6 月期间采用股骨近端接骨板固定的 86 例股骨颈骨折患者。这些患者根据螺钉构型分为两组：短、长螺纹空心螺钉（SLTS，n=38）和短螺纹空心螺钉（STS，n=48）。比较两组患者的影像学和临床结果，包括螺钉退出、骨不连、股骨头坏死、头干角（CCD）、股骨颈缩短量（FNS）和髋关节 Harris 评分（HHS）。
两组患者的术前特征，包括年龄、性别、Garden 分型、手术时间和复位质量，差异均无统计学意义（p>0.05）。与 STS 组（7.9°（6.3-11.0））相比，SLTS 组术后 CCD 角减小程度较小（-0.4°（-1.4-1.8））（p<0.001）。SLTS 组的 FNS 也较少（3.2（2.7-3.8）mm 比 5.1（4.2-5.9）mm，p<0.001）。所有患者均实现骨愈合，随访期间无股骨头坏死。SLTS 组的 HHS 评分更高（86.4±5.1），高于 STS 组（81.5±4.5）（p<0.001）。
股骨近端接骨板中短、长螺纹螺钉的混合构型能更好地抵抗内翻塌陷，对股骨颈骨折的功能结局更有利。
