髓内钉固定治疗 Pauwels Ⅲ型股骨颈骨折中内侧支撑钢板与转子间拉力螺钉增强效果的比较：一项回顾性临床研究。
Comparison of augmentation effects of medial buttress plate versus trochanteric lag screw in the cannulated screw fixation of Pauwels type III femoral neck fractures: A retrospective clinical study.
机构信息
Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
出版信息
Acta Orthop Traumatol Turc. 2023 Sep;57(5):250-257. doi: 10.5152/j.aott.2023.23066.
OBJECTIVE
This study aimed to compare the effects of a medial buttress plate (MBP) or a trochanteric lag screw (TLS) to augment cannulated screws (CSs) in fixing Pauwels type III femoral neck fractures.
METHODS
This retrospective study included 58 patients (21 female, 37 male; mean age=46 years; age=19-64 years) treated by CSs for Pauwels type III femoral neck fractures from 2014 to 2017. All the patients were divided into 2 groups based on the internal fixation patterns: the MBP-augmented group (group A, n=26) and the TLS group (group B, n=32). The mean age was 47 (range=24-57) years in group A and 45 (range=19-64) years in group B. The operation time, intraoperative blood loss, reduction quality, Harris score, and postoperative complications were recorded and compared between both groups.
RESULTS
All patients were followed up for an average of 44.8 months in group A and 47.3 months in group B (P=.406). No significant difference was noted in reduction quality (P=1.000). However, group A had a longer operation time (100.2 vs. 64.3 minutes, P < .001) and greater intraoperative blood loss (153.1 vs. 30.0 mL, P < .001) than group B. At the final follow-up, the union rate was equal between group A (96.2%) and group B (90.6%) (P=.760). The mean bone union time was 21.6 weeks in group A and 23.6 weeks in group B (P=.431). The delayed union rate was lower in group A (0%) than in group B (15.6%) (P < .001). The incidence of postoperative complications in terms of implant failure (7.7% vs. 28.1%, P=.048) and femoral neck shortening (7.7% vs. 28.1%, P=.048) were lower in group A than in group B. No significant difference was noted in avascular femoral head necrosis (P=1.000) and the Harris score (P=.659) between the 2 groups.
CONCLUSION
In the surgical treatment of Pauwels type III femoral neck fractures, medial buttress plating can offer fewer complications but equal avascular femoral head necrosis rate and functional outcome compared to trochanteric screw application.
LEVEL OF EVIDENCE
Level III, Therapeutic study.
目的
本研究旨在比较内侧支撑钢板（MBP）或转子下拉力螺钉（TLS）增强空心螺钉（CSs）固定 Pauwels Ⅲ型股骨颈骨折的效果。
方法
本回顾性研究纳入了 2014 年至 2017 年间采用 CSs 治疗 Pauwels Ⅲ型股骨颈骨折的 58 例患者（21 例女性，37 例男性；平均年龄 46 岁；年龄 19-64 岁）。所有患者均根据内固定方式分为两组：MBP 增强组（A 组，n=26）和 TLS 组（B 组，n=32）。A 组的平均年龄为 47（范围 24-57）岁，B 组为 45（范围 19-64）岁。记录并比较两组患者的手术时间、术中失血量、复位质量、Harris 评分和术后并发症。
结果
A 组平均随访 44.8 个月，B 组平均随访 47.3 个月（P=.406）。两组患者复位质量无显著差异（P=1.000）。然而，A 组的手术时间（100.2 分钟比 64.3 分钟，P<.001）和术中失血量（153.1 毫升比 30.0 毫升，P<.001）均大于 B 组。末次随访时，A 组（96.2%）与 B 组（90.6%）的愈合率相当（P=.760）。A 组骨愈合时间平均为 21.6 周，B 组为 23.6 周（P=.431）。A 组的延迟愈合率（0%）低于 B 组（15.6%）（P<.001）。A 组在术后并发症方面，植入物失败（7.7%比 28.1%，P=.048）和股骨颈缩短（7.7%比 28.1%，P=.048）的发生率低于 B 组。两组间在股骨头缺血性坏死（P=1.000）和 Harris 评分（P=.659）方面无显著差异。
结论
在 Pauwels Ⅲ型股骨颈骨折的手术治疗中，与应用转子下拉力螺钉相比，内侧支撑钢板固定可减少并发症，但股骨头缺血性坏死发生率和功能结果相当。
证据等级
III 级，治疗性研究。
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