Nan Fang Hospital of Southern Medical University, Guangzhou, China.
Department of Orthopaedics, The 73st Group Army Hospital of PLA (Key Orthopaedic Specialties Specialties of Xiamen City 2015347), Xiamen, China.
Orthop Surg. 2022 May;14(5):911-918. doi: 10.1111/os.13273. Epub 2022 Apr 21.
To investigate the outcomes of open reduction and internal fixation combined with medial buttress plate (MBP) and allograft bone-assisted cannulated screw (CS) fixation for patients with unstable femoral neck fracture with comminuted posteromedial cortex.
In a retrospective study of patients operated on for unstable femoral neck fractures with comminuted posteromedial cortex from March 2016 to August 2020, the clinical and radiographic outcomes of 48 patients treated with CS + MBP were compared with the outcomes of 54 patients treated with CS only. All patients in the CS + MBP group were fixed by three CS and MBP (one-third tubular plates or reconstructive plates) with bone allografts. The surgery-related outcomes and complications were evaluated, including operative time, blood loss, union time, femoral head necrosis, femoral neck shortening, and other complications after the operation. The Harris score was evaluated at 12 months after the operation.
All patients were followed up for 12-40 months. The average age of patients in the CS-only group (54 cases, 22 females) and CS + MBP group (48 cases, 20 females) was 48.46 ± 7.26 and 48.73 ± 6.38 years, respectively. More intraoperative blood loss was observed in the CS + MBP group than that of patients in CS-only group (153.45 ± 64.27 vs 21.86 ± 18.19 ml, t = 4.058, P = 0.015). The average operative time for patients in the CS + MBP group (75.35 ± 27.67 min) was almost double than that of patients in the CS-only group (36.87 ± 15.39 min) (t = 2.455, P < 0.001). The Garden alignment index of patients treated by CS + MBP from type I to type IV was 79%, 19%, 2%, and 0%, respectively. On the contrary, they were 31%, 43%, 24% and 2% for those in the CS-only group, respectively. The average healing times for the CS-only and CS + MBP groups were 4.34 ± 1.46 and 3.65 ± 1.85 months (t = 1.650, P = 0.102), respectively. Femoral neck shortening was better in the CS + MBP group (1.40 ± 1.73 mm, 9/19) than that in the CS-only group (4.33 ± 3.32 mm, 24/44). Significantly higher hip function was found in the CS + MBP group (85.60 ± 4.36 vs 82.47 ± 6.33, t = 1.899, P = 0.06). There was no statistical difference between femoral head necrosis (4% vs 11%, χ = 1.695, P = 0.193) and nonunion (6% vs 9%, χ = 0.318, P = 0.719).
For unstable femoral neck fractures with comminuted posteromedial cortex, additional MBP combined with bone allografts showed better reduction quality and neck length control than CS fixation only, with longer operative time and more blood loss.
探讨切开复位内固定联合内侧支撑钢板（MBP）和同种异体骨辅助空心螺钉（CS）固定治疗伴有粉碎后内侧皮质的不稳定股骨颈骨折的疗效。
回顾性分析 2016 年 3 月至 2020 年 8 月接受手术治疗的不稳定股骨颈骨折伴粉碎后内侧皮质的患者。将接受 CS+MBP 治疗的 48 例患者的临床和影像学结果与仅接受 CS 治疗的 54 例患者的结果进行比较。所有接受 CS+MBP 治疗的患者均采用 3 枚 CS 和 MBP（三分之一管状板或重建板）和同种异体骨固定。评估手术相关结果和并发症，包括手术时间、失血量、愈合时间、股骨头坏死、股骨颈缩短和术后其他并发症。术后 12 个月采用 Harris 评分评估髋关节功能。
所有患者均获得 12-40 个月随访。CS 单纯组（54 例，22 例女性）和 CS+MBP 组（48 例，20 例女性）患者的平均年龄分别为 48.46±7.26 岁和 48.73±6.38 岁。CS+MBP 组术中出血量明显多于 CS 单纯组（153.45±64.27 vs 21.86±18.19 ml，t=4.058，P=0.015）。CS+MBP 组的平均手术时间（75.35±27.67 min）几乎是 CS 单纯组（36.87±15.39 min）的两倍（t=2.455，P<0.001）。CS+MBP 组的 Garden 对线指数从 I 型到 IV 型分别为 79%、19%、2%和 0%，而 CS 单纯组则分别为 31%、43%、24%和 2%。CS 单纯组和 CS+MBP 组的平均愈合时间分别为 4.34±1.46 和 3.65±1.85 个月（t=1.650，P=0.102）。CS+MBP 组股骨颈缩短情况优于 CS 单纯组（1.40±1.73 mm，9/19）优于 CS 单纯组（4.33±3.32 mm，24/44）。CS+MBP 组髋关节功能明显优于 CS 单纯组（85.60±4.36 vs 82.47±6.33，t=1.899，P=0.06）。股骨头坏死发生率（4% vs 11%，χ 2=1.695，P=0.193）和不愈合发生率（6% vs 9%，χ 2=0.318，P=0.719）差异无统计学意义。
对于伴有粉碎后内侧皮质的不稳定股骨颈骨折，与单独 CS 固定相比，联合 MBP 和同种异体骨固定可提供更好的复位质量和颈长控制，但手术时间更长，失血量更多。
