Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200233, China.
Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
BMC Musculoskelet Disord. 2022 Nov 18;23(1):993. doi: 10.1186/s12891-022-05956-9.
Sliding compression fixation and length-stable fixation are two basic internal fixation concepts in the treatment of displaced femoral neck fractures. In this study, we aimed to compare the reoperation rates for different methodologies of internal fixation for femoral neck fractures in young and middle-aged population.
This a retrospective study. A total of 215 patients with displaced femoral neck fractures treated with cannulated screw fixation were enrolled and divided into the sliding compression and length-stable groups according to the fixation pattern. The occurrence of and reason for revision surgery within one year were recorded. Forty-five patients with complete CT data (including CT scanning on the first postoperative day and at the last follow up) were selected from the total sample. A newly established computerized image processing method was used to evaluate variations in the spatial location of screws.
The reoperation rate was significantly higher in the length-stable group (23.8%) than in the sliding compression group (7.3%). The rate of revision surgery due to nonunion was also higher in the length-stable group (11.4%) than in the sliding compression group (1.8%). However, no significant difference was observed in terms of joint penetration or soft tissue irritation. The sliding compression group (6.58 ± 3.18 mm) showed higher femoral neck shortening than length-stable group (4.16 ± 3.65 mm). When analyzing the spatial variations, a significantly greater screw withdrawal distance was observed in the sliding compression group than in the length-stable group, but with a smaller rotation angle.
Length-stable internal fixation of displaced femoral neck fractures may lead to an increased reoperation rate in young and middle-aged population.
Name of the registry: Chinese Clinical Trial Registry.
ChiCTR2000032327. Trial registration date: 2020-4-26.
滑动加压固定和长度稳定固定是治疗移位型股骨颈骨折的两种基本内固定概念。本研究旨在比较不同内固定方法治疗中青年移位型股骨颈骨折的翻修率。
这是一项回顾性研究。共纳入 215 例采用空心螺钉固定治疗的移位型股骨颈骨折患者，根据固定方式分为滑动加压组和长度稳定组。记录 1 年内翻修手术的发生和原因。从总样本中选择了 45 例具有完整 CT 数据（包括术后第 1 天和末次随访的 CT 扫描）的患者。采用一种新建立的计算机图像处理方法来评估螺钉空间位置的变化。
长度稳定组（23.8%）的翻修率明显高于滑动加压组（7.3%）。长度稳定组（11.4%）因不愈合而需翻修的比例也高于滑动加压组（1.8%）。然而，在关节穿透或软组织刺激方面无显著差异。滑动加压组（6.58±3.18mm）的股骨颈缩短程度高于长度稳定组（4.16±3.65mm）。在分析空间变化时，滑动加压组的螺钉拔出距离明显大于长度稳定组，但旋转角度较小。
对于中青年人群，采用稳定固定治疗移位型股骨颈骨折可能会导致翻修率增加。
名称：中国临床试验注册中心。
ChiCTR2000032327. 试验注册日期：2020-4-26.
