股骨颈系统螺钉固定治疗股骨颈骨折后颈短缩的发生率及影响因素。
Incidence and factors influencing neck shortening after screw fixation of femoral neck fractures with the femoral neck system.
机构信息
Department of Orthopaedics, Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Second Hospital of Xiamen University, The Third Clinical Medical College of Fujian Medical University, Fuzhou, 350007, China.
The Second Clinical Medical College of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.
出版信息
J Orthop Surg Res. 2023 Apr 24;18(1):317. doi: 10.1186/s13018-023-03787-5.
OBJECTIVE
To investigate the effects of postoperative femoral neck shortening in patients with femoral neck fractures fixed with femoral neck system screws (FNS) and to explore the factors influencing femoral neck shortening.
METHOD
To retrospectively analyze the data of 113 patients with femoral neck fractures admitted to the Second Hospital of Fuzhou City, affiliated with Xiamen University, between December 2019 and January 2022. Of these, 87 patients were followed up for more than 12 months, 49 men and 38 women: 36 cases of Garden I and II fractures and 51 cases of Garden III and IV fractures, to record the patient's hip Harris score at 12 months postoperatively. Patients were divided into femoral neck shortening group and femoral neck no shortening group according to their regular postoperative follow-up radiographic measurements. To count the incidence of femoral neck shortening, a comparison of postoperative complication rates and hip Harris scores between the two groups was made. Statistical comparison of the two groups and a multifactorial logistic regression analysis were also performed to analyze the factors affecting femoral neck shortening.
RESULTS
All 87 patients were followed up for more than 12 months after surgery. In 34 of these cases, neck shortening occurred, and the incidence rate was 39.1%. 15 cases of severe shortening, incidence of 17.2%; fracture healing 84 cases, fracture healing rate of 96.5%. The hip Harris score was 83.99 (81.95, 89.20) in the neck shortening group at 12 months postoperatively, 90.87 (87.95, 94.80) for the group without neck shortening; the difference between the two groups was statistically significant (P < 0.01). 32 cases of fracture healing in the neck shortening group at 12 months after surgery, fracture healing rate of 94.1%; 52 cases healed without neck shortening group, fracture healing rate of 98.1%. The difference between the two groups was not statistically significant (P = 0.337). High incidence of neck shortening after FNS fixation of femoral neck fractures, cortical comminution of the severed end, fracture fractionation and quality of reduction were significantly correlated with neck shortening.
CONCLUSION
High incidence of postoperative neck shortening after internal fixation of femoral neck fractures with the femoral neck system, the cortical comminution, the type of fracture, and the quality of fracture reduction are the influencing factors; femoral neck shortening can affect postoperative hip function, but does not affect fracture healing.
目的
探讨股骨颈系统螺钉固定股骨颈骨折患者术后股骨颈缩短的影响，并探讨影响股骨颈缩短的因素。
方法
回顾性分析 2019 年 12 月至 2022 年 1 月期间在厦门大学附属福州第二医院接受治疗的 113 例股骨颈骨折患者的临床资料。其中 87 例获得超过 12 个月的随访，男 49 例，女 38 例；GardenⅠⅡ型骨折 36 例，GardenⅢⅣ型骨折 51 例。记录患者术后 12 个月的髋关节 Harris 评分。根据术后定期随访的影像学测量结果，将患者分为股骨颈缩短组和股骨颈无缩短组。统计股骨颈缩短的发生率，比较两组术后并发症发生率和髋关节 Harris 评分。对两组进行统计学比较，并进行多因素 logistic 回归分析，以分析影响股骨颈缩短的因素。
结果
所有 87 例患者术后均获得超过 12 个月的随访。其中 34 例出现颈缩短，发生率为 39.1%。严重缩短 15 例，发生率为 17.2%；84 例骨折愈合，骨折愈合率为 96.5%。术后 12 个月股骨颈缩短组髋关节 Harris 评分为 83.99（81.95，89.20），无股骨颈缩短组为 90.87（87.95，94.80），两组比较差异有统计学意义（P<0.01）。术后 12 个月股骨颈缩短组骨折愈合 32 例，骨折愈合率为 94.1%；无股骨颈缩短组 52 例骨折愈合，骨折愈合率为 98.1%，两组比较差异无统计学意义（P=0.337）。股骨颈系统固定股骨颈骨折术后颈缩短发生率高，断端皮质粉碎、骨折分型和复位质量与颈缩短明显相关。
结论
股骨颈系统内固定股骨颈骨折术后颈缩短发生率高，断端皮质粉碎、骨折分型和复位质量是影响因素；股骨颈缩短会影响术后髋关节功能，但不影响骨折愈合。
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