Department of Orthopaedics, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, No. 24, Shijingshan Road, Beijing, 100043, China.
Department of orthopedics, The fourth medical center, General Hospital of Chinese PLA, Beijing, China.
Sci Rep. 2022 Jan 10;12(1):325. doi: 10.1038/s41598-021-03666-1.
Closed reduction and internal fixation with three cannulated compression screws is a common method for treating femoral neck fractures in young and middle-aged patients. Protocols including the inverted triangle configuration and dispersion of the screws still needed further supports. The purpose of this study was to explore a novel oblique triangle configuration (OTC) of three screws in fixing femoral neck fractures based on the morphology of the femoral neck isthmus (FNI). The computer-aided design modules were used to explore the ideal spatial configuration with largest triangle by three parallel screws. A univariate evaluation model was established based on the oval-like cross-section of the FNI. When the three screws were positioned by the OTC, Inverted Equilateral Triangle Configuration (IETC), and the Maximum Area Inverted Isosceles Triangle Configuration (MA-IITC) respectively, the proportion of area and circumference in the cross-section of FNI and the changing trend of proportion were compared under various torsion angles, eccentricity, and cross-sectional area of FNI. The area and circumference ratios of the parallel screws using the OTC method were significantly higher than in the IETC and MA-IITC groups. In the univariate evaluation model, the OTC area ratio and circumference ratio remained stable under the different femoral neck torsion angles, FNI cross-sectional area, and eccentricity. The OTC method provided an ideal spatial configuration for the FNA fixation with the largest area using three parallel screws. The position of the posterior screw was also away from the metaphyseal artery, potentially reducing the possibility of vascular injury and screw penetrating.
闭合复位和三根空心加压螺钉内固定是治疗中青年股骨颈骨折的常用方法。包括倒三角构型和螺钉分散在内的方案仍需要更多的支持。本研究旨在探讨一种基于股骨颈峡部（FNI）形态的新型三螺钉斜三角构型（OTC）固定股骨颈骨折的方法。使用计算机辅助设计模块来探索具有最大三角形的三根平行螺钉的理想空间构型。基于 FNI 的椭圆形横截面，建立了单变量评估模型。当三根螺钉分别采用 OTC、倒等边三角形构型（IETC）和最大面积倒等腰三角形构型（MA-IITC）定位时，在不同扭转角、偏心距和 FNI 横截面积下，比较 FNI 横截面上的面积和周长比例以及比例的变化趋势。OTC 方法中平行螺钉的面积和周长比在 IETC 和 MA-IITC 组中明显更高。在单变量评估模型中，OTC 面积比和周长比在不同的股骨颈扭转角、FNI 横截面积和偏心距下保持稳定。OTC 方法为使用三根平行螺钉固定 FNA 提供了最大面积的理想空间构型。后螺钉的位置也远离干骺端动脉，潜在地降低了血管损伤和螺钉穿透的可能性。
