Zheng Shunze, Lin Dongze, Chen Peisheng, Lin Chaohui, Chen Bin, Zheng Ke, Lin Fengfei
Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China.
Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China; Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China.
Injury. 2024 Jun;55(6):111564. doi: 10.1016/j.injury.2024.111564. Epub 2024 Apr 12.
The purpose of this study was to compare the outcomes of femoral neck shortening between the femoral neck system (FNS) and the cannulated cancellous screws (CCS) for displaced femoral neck fractures in young adults PATIENTS AND METHODS: In this retrospective analysis, 225 patients aged 18-65 years with displaced femoral neck fracture were divided into two groups according to internal fixation: 135 patients in the FNS group and 90 patients in the CCS group. The length of hospital stay, duration of surgery, intraoperative blood loss, quality of reduction, extent of femoral neck shortening, incidence of femoral neck shortening, femoral neck shortening at each follow-up visit, Harris hip score (HHS), reoperation, and complications were compared between the two groups.
The median follow-up time was 28.2 (26.0, 31.2) months in the FNS group and 30.2 (26.3, 34.7) months in the CCS group. The follow-up time, age, sex distribution, body mass index (BMI), mechanism of injury, injured side, length of hospital stay, time from injury to surgery, and fracture classification were similar between the groups. Duration of surgery was longer in the FNS group (65.0 (55.0, 87.0) min versus 55.0 (50.0, 65.0) min, P<0.001); intraoperative blood loss was greater in the FNS group (50.0 (20.0, 60.0) ml versus 20.0 (10.0, 35.0) ml, P<0.001). Femoral neck shortening was 2.4 (1.0, 4.5) mm in the FNS group versus 0.6 (0.0, 2.6) mm in the CCS group at 1 month postoperatively (P<0.001); 3.7 (1.8, 6.4) mm in the FNS group versus 1.2 (0.6, 3.8) mm in the CCS group at 3 months (P<0.001); 4.1(2.4, 7.7) mm in the FNS group versus 2.3 (1.1, 4.4) mm in the CCS group at 6 months (P<0.001); 4.2 (2.6, 7.7) mm in the FNS group versus 2.6 (1.3, 4.6) mm in the CCS group at 12 months (P<0.001); and 4.5 (2.8, 8.0) mm in the FNS group versus 2.8 (1.5, 4.8) mm in the CCS group at 18 months (P<0.001). The two groups showed no significant differences in HHS, reoperation, and reduction quality.
Compared to CCS, FNS is deficient in preventing femoral neck shortening. Future research should focus on improving FNS in terms of preventing femoral neck shortening.
本研究旨在比较股骨颈系统（FNS）和空心松质骨螺钉（CCS）治疗年轻成人移位型股骨颈骨折时股骨颈缩短的情况。
在这项回顾性分析中，将225例年龄在18 - 65岁的移位型股骨颈骨折患者根据内固定方式分为两组：FNS组135例，CCS组90例。比较两组患者的住院时间、手术时长、术中失血量、复位质量、股骨颈缩短程度、股骨颈缩短发生率、每次随访时的股骨颈缩短情况、Harris髋关节评分（HHS）、再次手术情况及并发症。
FNS组的中位随访时间为28.2（26.0，31.2）个月，CCS组为30.2（26.3，34.7）个月。两组间的随访时间、年龄、性别分布、体重指数（BMI）、损伤机制、受伤侧、住院时间、受伤至手术时间及骨折分型相似。FNS组的手术时长更长（65.0（55.0，87.0）分钟对55.0（50.0，65.0）分钟，P<0.001）；FNS组的术中失血量更多（50.0（20.0，60.0）毫升对20.0（10.0，35.0）毫升，P<0.001）。术后1个月时，FNS组的股骨颈缩短为2.4（1.0，4.5）毫米，CCS组为0.6（0.0，2.6）毫米（P<0.001）；术后3个月时，FNS组为3.7（1.8，6.4）毫米，CCS组为1.2（0.6，3.8）毫米（P<0.001）；术后6个月时，FNS组为4.1（2.4，7.7）毫米，CCS组为2.3（1.1，4.4）毫米（P<0.001）；术后12个月时，FNS组为4.2（2.6，7.7）毫米，CCS组为2.6（1.3，4.6）毫米（P<0.001）；术后18个月时，FNS组为4.5（2.8，8.0）毫米，CCS组为2.8（1.5，4.8）毫米（P<0.001）。两组在HHS、再次手术及复位质量方面无显著差异。
与CCS相比，FNS在预防股骨颈缩短方面存在不足。未来研究应聚焦于改进FNS以预防股骨颈缩短。
