Zhang Xinzhao, Zheng Changling, Huang Jin, Chen Hui, Lei Jie, Huang Cong
Department of Orthopedics, Ningde Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Ningde, 352100, China.
Heliyon. 2024 Jul 16;10(14):e34582. doi: 10.1016/j.heliyon.2024.e34582. eCollection 2024 Jul 30.
This study aimed to assess the efficacy of three different fixation methods in treating femoral neck fractures in young patients.
A retrospective analysis was conducted on 35 young patients with femoral neck fractures who underwent surgical treatment. Among them, 16, 12, and 7 patients underwent fixation with three cannulated compression screws (3CS), the femoral neck system (FNS), and the compound compression system (CCS), respectively. Data, including fracture classification, injury-to-surgery time, surgery duration, intraoperative blood loss, fluoroscopy instances, fracture healing time, complications, and Harris score at the final follow-up, were collected and analyzed to compare clinical outcomes among the three fixation methods.
All patients were followed for at least 6 months, exhibiting no significant differences in age, gender, injury side, fracture type, or injury-to-operation time among the three groups (P > 0.05). The FNS and CCS groups exhibited shorter operation durations and fewer intraoperative fluoroscopy instances compared to the 3CS group (P < 0.01). Despite the minimally invasive nature of 3CS, the FNS and CCS groups experienced higher intraoperative blood loss (P < 0.01). During follow-up, only one patient with 3CS fixation developed nonunion. Additionally, patients treated with 3CS demonstrated a higher incidence of femoral head necrosis and severe femoral neck shortening than the FNS and CCS groups. Excluding patients with combined nonunion, no significant difference in mean fracture healing time was observed among the three groups (P > 0.05). At the last follow-up, the FNS and CCS groups showed higher Harris scores (P < 0.05).
Both FNS and CCS are effective internal fixation systems for the treatment of femoral neck fractures in young patients, yielding more satisfactory clinical functional outcomes than 3CS. Comparatively, the CCS system presents a higher risk of iatrogenic rotation of the proximal fracture segment. Therefore, we advocate the insertion of two to three 2.5 mm Kirschner wires from the upper edge of the femoral neck along the axial direction before CCS lag screw insertion to resist iatrogenic rotational stress.
本研究旨在评估三种不同固定方法治疗年轻患者股骨颈骨折的疗效。
对35例行手术治疗的年轻股骨颈骨折患者进行回顾性分析。其中，分别有16例、12例和7例患者采用三枚空心加压螺钉（3CS）、股骨颈系统（FNS）和复合加压系统（CCS）进行固定。收集并分析包括骨折分类、受伤至手术时间、手术时长、术中出血量、透视次数、骨折愈合时间、并发症以及末次随访时的Harris评分等数据，以比较三种固定方法的临床疗效。
所有患者均随访至少6个月，三组患者在年龄、性别、受伤侧、骨折类型或受伤至手术时间方面无显著差异（P>0.05）。与3CS组相比，FNS组和CCS组的手术时长更短，术中透视次数更少（P<0.01）。尽管3CS具有微创性，但FNS组和CCS组的术中出血量更多（P<0.01）。随访期间，3CS固定的患者中仅有1例发生骨不连。此外，3CS治疗的患者股骨头坏死和严重股骨颈缩短的发生率高于FNS组和CCS组。排除合并骨不连的患者后，三组的平均骨折愈合时间无显著差异（P>0.05）。在末次随访时，FNS组和CCS组的Harris评分更高（P<0.05）。
FNS和CCS都是治疗年轻患者股骨颈骨折的有效内固定系统，其临床功能结局比3CS更令人满意。相比之下，CCS系统导致近端骨折段医源性旋转的风险更高。因此，我们主张在CCS拉力螺钉置入前，从股骨颈上缘沿轴向插入2至3枚2.5mm克氏针，以抵抗医源性旋转应力。
