Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
The Orthopedic Research Centre, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
Orthop Surg. 2022 Sep;14(9):1964-1971. doi: 10.1111/os.13285. Epub 2022 Jul 18.
To explore the clinical effect of a new type of bidirectional pressurized porous tantalum screw (PTS) internal fixation in treating femoral neck fractures (FNFs).
In this study, geometric models of FNF were first established via reverse engineering method, followed by stimulation of the strength of PTSs in fixation of FNFs. A randomized control trial study was then conducted of 41 patients with FNF from October 2015 to December 2018. These patients included 12 males and 29 females with an average age of 59.9. The 41 patients were randomly divided into two groups: cannulated compression screws (CCSs) group (n = 21) and PTSs group (n = 20). Treatment outcomes in patients were evaluated using multiple imaging techniques, including X-ray and digital subtraction angiography scanning as well as functional recovery Harris hip score. Without other postoperative complications, the primary outcome was defined as fracture healing after FNF internal fixation. Secondary outcomes are the incidence of the avascular necrosis of femoral head (ANFH), fracture nonunion, and reoperation rate.
Following PTS internal fixation of FNF, finite element results revealed a firmly fixed fracture with a slight displacement of less than 0.5 mm. At follow-up, we found a statistically significant difference in Harris scores in the two groups at 1 month and 3 months post-surgery. In the PTSs group, there was no case of ANFH and fracture nonunion, and the average healing time was 94.45 ± 6.47 days. In the CCSs group, there were four cases of ANFH, the necrosis rate was 19.05% (4/21). There was one case of fracture nonunion in the CCSs group, the nonunion fracture rate was 4.76% (1/21), and the average healing time was 122.54 ± 11.37 days. Five patients underwent total hip arthroplasty, and the reoperation rate was 23.81% (5/21). There were significant differences in the postoperative complications, fracture healing time, and reoperation rate between the two groups (p < 0.05).
PTSs fixation of FNF at the center, does not only avoid the destruction of blood supply in the femoral head and reduction in the incidence of postoperative complications of FNFs, but also induces early bone ingrowth and promotes fracture healing. These findings provide a potential surgical internal fixation system for treating FNFs.
探讨新型双向加压多孔钽钉（PTS）内固定治疗股骨颈骨折（FNF）的临床效果。
本研究首先采用逆向工程方法建立 FNF 的几何模型，然后刺激 PTS 固定 FNF 的强度。2015 年 10 月至 2018 年 12 月，我们进行了一项 41 例 FNF 患者的随机对照试验研究。这些患者包括 12 名男性和 29 名女性，平均年龄为 59.9 岁。将 41 例患者随机分为两组：空心加压螺钉（CCS）组（n=21）和 PTS 组（n=20）。使用 X 射线和数字减影血管造影扫描以及功能恢复 Harris 髋关节评分等多种影像学技术评估患者的治疗结果。无其他术后并发症时，FNF 内固定后，主要结果定义为骨折愈合。次要结果是股骨头缺血性坏死（ANFH）、骨折不愈合和再手术率的发生率。
FNF 经 PTS 内固定后，有限元结果显示骨折固定牢固，位移小于 0.5mm。随访时，我们发现术后 1 个月和 3 个月两组的 Harris 评分有统计学差异。在 PTS 组中，无 ANFH 和骨折不愈合病例，平均愈合时间为 94.45±6.47 天。在 CCS 组中，有 4 例 ANFH，坏死率为 19.05%（4/21）。CCS 组有 1 例骨折不愈合，骨折不愈合率为 4.76%（1/21），平均愈合时间为 122.54±11.37 天。5 例患者行全髋关节置换术，再手术率为 23.81%（5/21）。两组术后并发症、骨折愈合时间和再手术率差异有统计学意义（p<0.05）。
PTS 固定 FNF 中心不仅避免了股骨头血供破坏和减少 FNF 术后并发症，而且还诱导早期骨长入，促进骨折愈合。这些发现为治疗 FNF 提供了一种潜在的手术内固定系统。
