Department of Orthopaedic Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China.
BMC Musculoskelet Disord. 2023 Oct 18;24(1):823. doi: 10.1186/s12891-023-06959-w.
This study aimed to evaluate the clinical efficacy of the femoral neck system alone or in combination with a cannulated screw compared with other internal fixation methods for treating femoral neck fractures. We further investigated the predictive effects of tip-apex distance (TAD) on clinical efficacy.
Data from 129 young adults with femoral neck fractures followed up at The Second Affiliated Hospital of Fujian Medical University between January 2016 and June 2022 were retrospectively collected. The patients were categorized into four groups based on the different internal fixation methods. Analysis and comparisons of the four group were performed according to age, ASA score, operation time, blood loss, fracture classification, fracture healing time, Harris score, TAD value, presence of complications (osteonecrosis of the femoral head, screw failure, and femoral neck shortening), and changes in the neck-shaft angle.
All 129 patients were followed up for at least one year. The group who received treatment with the femoral neck system combined with a cannulated screw exhibited the shortest fracture healing time. Differences were observed in the change of neck-shaft angle among the four groups (P < 0.001), with the smallest change observed in the aforementioned group (0.76 ± 0.54°). The femoral neck shortening was also lower in groups with the femoral neck system or combined with a cannulated screw. At the last follow-up surgery, the combined treatment group achieved the highest HHS score. Subgroup analysis revealed that when the TAD was less than 25 and 49 mm for the femoral neck system and combined groups, respectively, there was less femoral neck shortening, less change in the neck-shaft angle, and a higher HHS score.
The femoral neck system alone or combined with a cannulated screw demonstrated better short-term efficacy in the treatment of femoral neck fractures. Furthermore, TAD may serve as a predictive indicator of the potential success of femoral neck fracture treatment.
本研究旨在评估股骨颈系统单独或联合空心螺钉与其他内固定方法治疗股骨颈骨折的临床疗效。我们进一步探讨了尖顶距（TAD）对临床疗效的预测作用。
回顾性收集 2016 年 1 月至 2022 年 6 月福建医科大学附属第二医院收治的 129 例青年股骨颈骨折患者的临床资料。根据不同的内固定方法将患者分为四组。对四组患者的年龄、ASA 评分、手术时间、出血量、骨折分型、骨折愈合时间、Harris 评分、TAD 值、并发症（股骨头坏死、螺钉失效、股骨颈缩短）发生情况及颈干角变化进行分析比较。
129 例患者均获得至少 1 年随访。股骨颈系统联合空心螺钉组骨折愈合时间最短。四组患者颈干角变化差异有统计学意义（P < 0.001），其中股骨颈系统联合空心螺钉组变化最小（0.76 ± 0.54°）。股骨颈缩短也较低。末次随访时，股骨颈系统联合空心螺钉组的 HHS 评分最高。亚组分析显示，股骨颈系统和联合组 TAD 分别小于 25 和 49 mm 时，股骨颈缩短更少，颈干角变化更小，HHS 评分更高。
股骨颈系统单独或联合空心螺钉治疗股骨颈骨折近期疗效较好。TAD 可能是股骨颈骨折治疗潜在成功的预测指标。
