Department of Orthopedics, Fuzhou Second General Hospital, Fujian Provincial Clinical Medical Research Center for Trauma Orthopedics Emergency and Rehabilitation, Fuzhou, China.
Clinical Medical Department, Fujian Medical University, Fuzhou, China.
Orthop Surg. 2024 Dec;16(12):2967-2975. doi: 10.1111/os.14232. Epub 2024 Sep 1.
Early femoral neck shortening after femoral neck system (FNS) fixation for displaced femoral neck fractures can occur in 22.3%-39.1% of cases, leading to decreased hip joint function. This study aimed to investigate the effectiveness of using an anti-shortening screw (ASS) in FNS fixation to prevent postoperative femoral neck shortening in displaced femoral neck fractures.
We retrospectively analyzed 106 cases of displaced femoral neck fractures treated with FNS at the Hospital from April 2020 to April 2023. Patients were divided into two groups based on the use of an ASS: the traditional group and the ASS group, each consisting of 53 cases. The ASS group was age-matched with the traditional group treated during the same period without an ASS. The study variables included age, sex, body mass index (BMI), smoking and drinking history, injury mechanism, side of injury, fracture type, surgical time, intraoperative blood loss, Harris Hip Score (HHS) at the final follow-up, radiographic assessment (femoral neck shortening), and complications (infection, femoral head necrosis, nonunion, and secondary surgery). Statistical analysis was performed using SPSS software, with continuous and categorical variables analyzed using appropriate parametric (t-test) and nonparametric (Mann-Whitney U test) tests, and chi-square or Fisher's exact tests, respectively. A p-value <0.05 was considered significant.
There were no significant differences in background characteristics between the traditional and ASS groups. The shortening distance at postoperative day 1 did not differ significantly between the two groups (0 vs. 0 mm, p = 0.120). However, at 1, 3 months, and 1 year postoperatively, the femoral neck shortening in the ASS group was significantly less than that in the traditional group (1 month: 2.3 vs. 3.1 mm, p = 0.007; 3 months: 2.6 vs. 3.5 mm, p = 0.005; 1 year: 2.6 vs. 3.5 mm, p = 0.002). The ASS group also had a significantly lower shortening distance during the fracture healing process (0.9 vs. 2.7 mm, p = 0.005). The incidence of moderate to severe shortening (≥5 mm) at 1 year postoperatively was lower in the ASS group compared with the traditional group (15.1% vs. 37.7%, p = 0.001). The ASS group had a longer surgical time (63.0 ± 13.4 vs. 73.0 ± 23.2 min, p = 0.008) and a higher HHS (90.7 vs. 94.8, p = 0.008). There was no significant difference in fracture healing time or postoperative complications between the two groups. The traditional group had 3.8% cutouts, 7.5% nonunions, 5.7% avascular necrosis, and 7.5% secondary hip replacements. The ASS group saw 0% cutouts, 1.9% nonunions, 3.8% avascular necrosis, and 3.8% hip replacements. No significant differences in complication rates (p > 0.05).
The use of an ASS in FNS fixation for displaced femoral neck fractures can reduce the degree of postoperative shortening and improve hip joint function.
股骨颈系统（FNS）固定治疗移位股骨颈骨折后，早期股骨颈缩短的发生率为 22.3%-39.1%，导致髋关节功能下降。本研究旨在探讨在 FNS 固定中使用抗缩短螺钉（ASS）预防移位股骨颈骨折术后股骨颈缩短的效果。
我们回顾性分析了 2020 年 4 月至 2023 年 4 月在我院接受 FNS 治疗的 106 例移位股骨颈骨折患者。根据是否使用 ASS 将患者分为两组：传统组和 ASS 组，每组 53 例。ASS 组与同期未使用 ASS 的传统组进行年龄匹配。研究变量包括年龄、性别、体重指数（BMI）、吸烟和饮酒史、损伤机制、损伤侧、骨折类型、手术时间、术中失血量、最终随访时的 Harris 髋关节评分（HHS）、影像学评估（股骨颈缩短）和并发症（感染、股骨头坏死、不愈合和二次手术）。使用 SPSS 软件进行统计分析，连续和分类变量分别使用适当的参数（t 检验）和非参数（Mann-Whitney U 检验）进行分析，卡方或 Fisher 确切检验分别用于分类变量。p 值<0.05 被认为具有统计学意义。
传统组和 ASS 组在背景特征方面无显著差异。两组术后第 1 天的缩短距离无显著差异（0 与 0mm，p=0.120）。然而，在术后 1、3 个月和 1 年时，ASS 组的股骨颈缩短程度明显小于传统组（1 个月：2.3 与 3.1mm，p=0.007；3 个月：2.6 与 3.5mm，p=0.005；1 年：2.6 与 3.5mm，p=0.002）。ASS 组在骨折愈合过程中的缩短距离也明显较低（0.9 与 2.7mm，p=0.005）。术后 1 年时中度至重度缩短（≥5mm）的发生率 ASS 组明显低于传统组（15.1%与 37.7%，p=0.001）。ASS 组的手术时间更长（63.0±13.4 与 73.0±23.2min，p=0.008），HHS 更高（90.7 与 94.8，p=0.008）。两组的骨折愈合时间和术后并发症无显著差异。传统组有 3.8%的切出，7.5%的不愈合，5.7%的股骨头坏死和 7.5%的二次髋关节置换。ASS 组分别有 0%的切出，1.9%的不愈合，3.8%的股骨头坏死和 3.8%的髋关节置换。两组并发症发生率无显著差异（p>0.05）。
在 FNS 固定治疗移位股骨颈骨折中使用 ASS 可减少术后缩短程度，改善髋关节功能。
