Texas Christian University School of Medicine, Fort Worth, TX.
Fort Worth Orthopedic Trauma Surgeons, Fort Worth, TX.
J Orthop Trauma. 2024 Aug 1;38(8):403-409. doi: 10.1097/BOT.0000000000002828.
The objective of this study was to determine the difference in failure rates of surgical repair for displaced femoral neck fractures in patients younger than 60 years of age according to fixation strategy.
This is a retrospective, comparative cohort study.
Twenty-six Level 1 North American trauma centers.
Patients younger than 60 years of age with a displaced femoral neck fracture (OTA 31-B2, B3) undergoing surgical repair from 2005 to 2017.
Patient demographics, injury characteristics, repair methods used, and treatment failure (nonunion/failed fixation, avascular necrosis, and need for secondary surgery) were compared according to fixation strategy.
Five hundred and sixty-five patients met inclusion criteria and were studied. The mean age was 42 years, 36% were female, and the average Pauwels' angle of fractures was 55 degrees. There were 305 patients treated with multiple cannulated screws (MCS) and 260 treated with a fixed-angle (FA) construct. Treatment failures were 46% overall, but was more likely to occur in MCS constructs versus FA devices (55% vs. 36%, P < 0.001). When FA constructs were substratified, the use of a sliding hip screw with addition of a medial femoral neck buttress plate (FNBP) and "antirotation" (AR) screw demonstrated better results than either FNBP or AR screw alone or neither with the lowest overall construct failure rate of 11% (P < 0.036).
Historically used fixation constructs for femoral neck fractures (eg, multiple cannulated screws and sliding hip screw) in young and middle-aged adults performed poorly compared with more recently proposed constructs, including those using a medial femoral neck buttress plate and an antirotation screw. Fixed-angle constructs outperformed multiple cannulated screws overall, and augmentation of fixed-angle constructs with a medial femoral neck buttress plate and antirotation screw improved the likelihood of successful treatment. Surgeons should prioritize fixation decisions when repairing displaced femoral neck fractures in patients.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在根据固定策略，确定 60 岁以下移位股骨颈骨折患者手术修复的失败率差异。
这是一项回顾性、比较队列研究。
26 家北美 1 级创伤中心。
2005 年至 2017 年期间接受手术修复的年龄小于 60 岁、有移位股骨颈骨折（OTA 31-B2、B3）的患者。
根据固定策略比较患者人口统计学特征、损伤特征、使用的修复方法以及治疗失败（骨不连/固定失败、股骨头坏死和需要二次手术）。
符合纳入标准的 565 名患者进行了研究。平均年龄为 42 岁，36%为女性，骨折平均 Pauwels 角为 55 度。305 例患者采用多枚空心钉（MCS）治疗，260 例采用固定角度（FA）装置治疗。总的治疗失败率为 46%，但在 MCS 组中更常见（55%比 36%，P<0.001）。当 FA 装置分层时，与单独使用内侧股骨颈支撑板（FNBP）或抗旋转（AR）螺钉或两者均不使用相比，使用滑动髋螺钉加内侧股骨颈支撑板的装置（FNBP）和“抗旋转”（AR）螺钉的效果更好，整体构建失败率最低，为 11%（P<0.036）。
与最近提出的包括使用内侧股骨颈支撑板和抗旋转螺钉的构建相比，年轻和中年患者股骨颈骨折（如多枚空心钉和滑动髋螺钉）的传统固定构建表现不佳。固定角度构建物总体上优于多枚空心钉，在固定角度构建物中加入内侧股骨颈支撑板和抗旋转螺钉可提高治疗成功的可能性。当修复患者的移位股骨颈骨折时，外科医生应优先考虑固定决策。
治疗性 3 级。请参阅作者说明，以获取完整的证据水平描述。
