Sadeghpour Alireza, Mahdipour Shahab, Ghanjpour Sales Jafar, Aslani Hossein, Moharrami Mohammad Reza, Alizadeh Hadi
Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
J Orthop. 2023 Dec 3;51:32-38. doi: 10.1016/j.jor.2023.11.074. eCollection 2024 May.
The incidence of femoral neck fractures in osteoporotic patients is rising worldwide and is associated with significant increases in healthcare and social costs, as well as dependency. Improving minimally invasive treatment strategies, including internal fixation with screws, can result in favorable clinical outcomes and lesser incidence of complications, while preserving the hip. This study compared the outcomes of using non-cannulated cancellous screws (NCS) and cannulated cancellous screws (CS) in the internal fixation of undisplaced intracapsular femoral neck fractures (UIFNF) of osteoporotic patients of Iranian descent.
This randomized clinical trial was conducted on the patients referring to an institutional tertiary hospital in northwestern Iran between March 2020 and June 2021. The patients' preoperative, perioperative, and postoperative characteristics were evaluated for at least two years. Primary endpoints were defined as the incidence of hip-related complications, while secondary endpoints were assessed based on the patients' hip function using Harris Hip Score (HHS).
Fifty-seven patients with osteoporosis and UIFNF were included in the final analysis, with 27 patients in the NCS group and 30 patients in the CS group. The surgical duration, the amount of intraoperative blood loss, and the frequency of C-arm were considerably lower in the CS group (p < 0.05). The incidence of implant failure was higher in the NCS group (p = 0.04). Screw migration occurred more frequently in the CS group (p = 0.03). The HHS values were significantly higher for the NCS group than those of the CS group at both the 1-year and 2-years of follow-up assessments (1 year, p = 0.007; 2 years, p = 0.001).
Fixation using CS was accompanied by enhanced perioperative outcomes and lower implant failure rates compared to the NCS group. However, patients in the NCS group posed a reduced risk of complications, including screw migration, and experienced a long-term improvement in HHS scores.
骨质疏松患者股骨颈骨折的发病率在全球范围内呈上升趋势，这与医疗保健和社会成本的显著增加以及依赖性增加有关。改进包括螺钉内固定在内的微创治疗策略，可产生良好的临床效果，降低并发症发生率，同时保留髋关节。本研究比较了非空心松质骨螺钉（NCS）和空心松质骨螺钉（CS）在伊朗裔骨质疏松患者无移位囊内股骨颈骨折（UIFNF）内固定中的应用效果。
本随机临床试验于2020年3月至2021年6月在伊朗西北部一家机构三级医院就诊的患者中进行。对患者的术前、围手术期和术后特征进行了至少两年的评估。主要终点定义为髋关节相关并发症的发生率，次要终点则根据患者使用Harris髋关节评分（HHS）的髋关节功能进行评估。
最终分析纳入了57例骨质疏松合并UIFNF患者，其中NCS组27例，CS组30例。CS组的手术时间、术中失血量和C形臂使用频率显著更低（p<0.05）。NCS组的植入物失败发生率更高（p=0.04）。CS组螺钉移位更频繁（p=0.03）。在1年和2年的随访评估中，NCS组的HHS值均显著高于CS组（1年，p=0.007；2年，p=0.001）。
与NCS组相比，使用CS固定的围手术期效果更好，植入物失败率更低。然而，NCS组患者发生包括螺钉移位在内的并发症风险较低，且HHS评分有长期改善。
