School of Medicine, Nankai University, Tianjin, China.
Department of Orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Taiyuan, China.
Orthop Surg. 2022 Apr;14(4):720-729. doi: 10.1111/os.13223. Epub 2022 Mar 18.
To investigate whether four-screw fixation in rhombic configuration could improve the clinical outcomes and decrease the complication rate compared with three-screw fixation in inverted triangle configuration in elderly patients with nondisplaced femoral neck fractures.
From January 2018 to January 2019, 91 elderly patients with nondisplaced femoral neck fractures who were treated with a cannulated screw system were reviewed retrospectively. The inverted triangle configuration was applied in 51 patients and rhombic configuration in 40 patients. The demographic and perioperative information of the patients were extracted from medical records and surgical records. Variables including incision size, surgical blood loss, surgical time, fluoroscopy time, hospital stays, fracture union time, postoperative visual analogue scale (VAS) scores, and complications were compared between the two groups. Also, Harris hip score at the final follow-up was used to evaluate the functional outcomes.
All patients were followed up from 24 to 36 months, with an average of 29.75 months. The average age of patients was 72.37 ± 7.16 years. No significant differences were found between the two groups with regard to patients' age, gender, affected side, Garden classification, Pauwels classification and comminution of posterior wall (P > 0.05). We found shorter incision size (P < 0.001), less blood loss (P = 0.020), less surgical time (P = 0.026), and shorter fluoroscopy time (P < 0.001) in inverted triangle configuration group. However, shorter hospital stays (P = 0.001) and fracture union time (P = 0.002) were found in the rhombic configuration group. The VAS scores were lower in the rhombic configuration group at the first (P < 0.001) and third months (P = 0.010), but no significant difference was found at the sixth month (P = 0.075). Meanwhile, the total complication rate was relatively lower in the rhombic configuration group compared to the inverted triangle configuration group (P = 0.041). Harris hip score presented no significant difference between the two groups at final follow-up (P = 0.078). No wound infection or cortical perforation occurred in either group.
Four-screw fixation in rhombic configuration was superior to three-screw fixation in inverted triangle configuration in the treatment of nondisplaced femoral neck fractures in elderly patients in terms of less early postsurgical pain, shorter fracture union time, and lower complication rate.
探讨在老年股骨颈无移位骨折患者中，与三枚螺钉倒三角固定相比，菱形固定能否改善临床疗效并降低并发症发生率。
回顾性分析 2018 年 1 月至 2019 年 1 月采用空心螺钉系统治疗的 91 例老年股骨颈无移位骨折患者的临床资料，其中 51 例采用三枚螺钉倒三角固定，40 例采用四枚螺钉菱形固定。从病历和手术记录中提取患者的人口统计学和围手术期信息。比较两组患者的切口大小、手术失血量、手术时间、透视时间、住院时间、骨折愈合时间、术后视觉模拟评分（VAS）和并发症。末次随访时采用 Harris 髋关节评分评估功能结果。
所有患者随访 24 至 36 个月，平均 29.75 个月。患者平均年龄为 72.37±7.16 岁。两组患者在年龄、性别、患侧、Garden 分型、Pauwels 分型和后壁粉碎程度方面无统计学差异（P＞0.05）。我们发现倒三角固定组的切口更小（P＜0.001）、失血量更少（P=0.020）、手术时间更短（P=0.026）、透视时间更短（P＜0.001）。然而，菱形固定组的住院时间（P=0.001）和骨折愈合时间（P=0.002）更短。菱形固定组在第 1 个月（P＜0.001）和第 3 个月（P=0.010）的 VAS 评分较低，但在第 6 个月（P=0.075）无统计学差异。同时，菱形固定组的总并发症发生率低于倒三角固定组（P=0.041）。末次随访时，两组患者的 Harris 髋关节评分无统计学差异（P=0.078）。两组均未发生伤口感染或皮质穿孔。
在老年股骨颈无移位骨折患者中，四枚螺钉菱形固定在术后早期疼痛减轻、骨折愈合时间缩短和降低并发症发生率方面优于三枚螺钉倒三角固定。
