Department of Orthopedics and Traumatology, Peking University People's Hospital, Beijing, People's Republic of China.
The Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, People's Republic of China.
Sci Rep. 2022 Feb 2;12(1):1743. doi: 10.1038/s41598-021-03494-3.
The choices of the treatments for femoral neck fractures (FNF) remain controversial. The purpose of this study is to evaluate the prognoses of the variable pitch fully threaded headless cannulated screws (HCS) in the fixation of femoral neck fractures and to compare them with those of partially threaded cannulated screws (PCS). Between 1st January 2012 and 31st December 2016, there were 89 patients with the main diagnose of FNF who accepted the treatment of closed reduction cannulated screw fixation in Peking University People's Hospital. 34 cases of PCS and 23 cases of HCS met the criterion. The characteristics, prognoses and the imaging changes of all cases were described and the differences between the two groups were compared. Statistical analyses were performed using SPSS version 23.0 (SPSS Inc., USA). Mann-Whitney U test, Analysis of Variance and Chi-square test were used. Statistical significance was defined as P value (two sided) less than 0.05. There was no significant difference in the general characteristics, fracture classifications and reduction quality between the two groups. HCS group had a significant lower angle decrease rate (30.4% vs. 58.8%, P = 0.035), femoral neck shortening rate (26.1% vs. 52.9%, P = 0.044) and screw back-sliding rate (21.7% vs. 50.0%, P = 0.032), but a higher screw cut-out rate (21.7% vs. 0.0%, P = 0.008). In non-displacement fracture subgroup, HCS had significant higher Harris Score (92 vs. 90, P = 0.048). Compared with PCS, HCS had a lower screw back-sliding rate, femoral shortening rate, angle decrease rate and similar function score, but would result in more screw cut-outs in displaced FNF. As a conclusion, HCS should not be used in displaced FNF due to its higher screw cut-out rate, and its potential advantage in non-displaced FNF needs to be further proved. Further qualified investigations with a larger scale of patients and longer follow-up are needed in the future.
股骨颈骨折（FNF）的治疗选择仍存在争议。本研究旨在评估不同螺距全螺纹无头空心加压螺钉（HCS）固定股骨颈骨折的预后，并将其与部分螺纹空心加压螺钉（PCS）进行比较。2012 年 1 月 1 日至 2016 年 12 月 31 日，北京大学人民医院共有 89 例主要诊断为 FNF 的患者接受闭合复位空心螺钉固定治疗。其中 34 例 PCS 和 23 例 HCS 符合标准。描述了所有病例的特征、预后和影像学变化，并比较了两组之间的差异。采用 SPSS 23.0 版（SPSS Inc.，USA）进行统计分析。采用 Mann-Whitney U 检验、方差分析和卡方检验。P 值（双侧）小于 0.05 为差异有统计学意义。两组患者一般特征、骨折分类和复位质量无显著差异。HCS 组角度减小率（30.4%比 58.8%，P=0.035）、股骨颈缩短率（26.1%比 52.9%，P=0.044）和螺钉后退率（21.7%比 50.0%，P=0.032）显著降低，但螺钉脱出率（21.7%比 0.0%，P=0.008）显著升高。在无移位骨折亚组中，HCS 的 Harris 评分（92 分比 90 分，P=0.048）较高。与 PCS 相比，HCS 的螺钉后退率、股骨颈缩短率、角度减小率较低，功能评分相似，但在移位 FNF 中螺钉脱出率较高。结论：由于 HCS 螺钉脱出率较高，不应用于移位 FNF，其在非移位 FNF 的潜在优势需要进一步证实。未来需要进一步进行更大规模、更长随访的合格研究。
