Rajnish Rajesh Kumar, Srivastava Amit, Rathod Pratik M, Haq Rehan Ul, Aggarwal Sameer, Kumar Prasoon, Dhammi Ish Kumar, Dadra Ankit
Department of Orthopedics, Adesh Medical College and Hospital, Shahabad, Haryana, India.
Department of Orthopedics, University College of Medical Sciences and GTB Hospital, Delhi, India.
J Orthop. 2022 May 11;32:52-59. doi: 10.1016/j.jor.2022.05.007. eCollection 2022 Jul-Aug.
Management of neck of femur fractures depend upon the age of presentation and it ranges from internal fixation to arthroplasty. In a relatively young population, anatomical reduction with stable internal fixation is the preferred treatment modality; the choice of implants available are multiple cannulated cancellous screws, dynamic hip screws, and the newly devised femoral neck system. The fracture configuration and pattern dictate the ideal implant to be utilized, with the femoral neck system documented to be apt for all the fracture types, while the cannulated screws are deemed better for stable fractures.
A primary electronic search was conducted on databases of Medline, Scopus, Scopus, Cochrane Library, and Embase, to look for articles published between 1 January 2010 to 22 November 2021. Studies including adults with femoral neck fractures treated with internal fixation with femoral neck system and comparing them with internal fixation with cannulated cancellous screws in terms of variables like mean surgical duration, loss of blood, length of incision, fluoroscopy time, duration of hospital stay and outcomes like union time, complications, functional outcomes, Visual Analogue Score, and femoral neck shortening, were included.
6 retrospective studies with 371 patients (224 males,147 females) (164: FNS; 207: CCS) were included. Our analysis demonstrated no statistically significant difference in terms of duration of surgery, incision length, and length of hospital stay, there was more blood loss in FNS, but less fluoroscopy time. The fracture union time was lesser for the FNS group and also the femoral shortening was lesser in it. There was no difference in terms of complications, pain relief, and functional outcomes.
Femoral neck system is a new and effective implant for femoral neck fractures in the young with faster union rates and lesser neck shortening through an incision similar to the conventional multiple cancellous screws. It has additional advantages of lesser fluoroscopy exposure to the patient and the OT personnel. However, the rates of complications like implant failure, non-unions, and avascular necrosis are similar to the cannulated screws and either of the implants do not offer any advantage in the final functional status and pain relief to the patient over each other.
股骨颈骨折的治疗取决于就诊时的年龄，范围从内固定到关节置换术。在相对年轻的人群中，解剖复位并进行稳定的内固定是首选的治疗方式；可用的植入物有多种空心松质骨螺钉、动力髋螺钉以及新设计的股骨颈系统。骨折的形态和类型决定了要使用的理想植入物，据记载股骨颈系统适用于所有骨折类型，而空心螺钉被认为更适合稳定型骨折。
在Medline、Scopus、Cochrane图书馆和Embase数据库中进行了一次初步电子检索，以查找2010年1月1日至2021年11月22日期间发表的文章。纳入的研究包括成年股骨颈骨折患者，这些患者接受了股骨颈系统内固定治疗，并在平均手术时间、失血量、切口长度、透视时间、住院时间等变量以及愈合时间、并发症、功能结局、视觉模拟评分和股骨颈缩短等结局方面，与接受空心松质骨螺钉内固定的患者进行比较。
纳入了6项回顾性研究，共371例患者（男性224例，女性147例）（164例：股骨颈系统；207例：空心螺钉）。我们的分析表明，在手术时间、切口长度和住院时间方面没有统计学上的显著差异，股骨颈系统组的失血量更多，但透视时间更少。股骨颈系统组的骨折愈合时间更短，股骨缩短也更少。在并发症、疼痛缓解和功能结局方面没有差异。
股骨颈系统是一种用于年轻患者股骨颈骨折的新型有效植入物，通过与传统多根松质骨螺钉相似的切口，具有更快的愈合率和更少的颈缩短。它还有减少患者和手术室人员透视暴露的额外优势。然而，植入物失败、不愈合和缺血性坏死等并发症的发生率与空心螺钉相似，并且两种植入物在最终功能状态和患者疼痛缓解方面对彼此均无优势。
