Zhang Xiaolong, Feng Xiwen, Ouyang Lingfei, Shu Shan, Zhuang Lebin, Gui Weichao, Zhang Sheng, Yao Zilong, Wang Gang, Liao Hua, Hu Jijie
Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Guangzhou University of Traditional Chinese Medicine ShunDe Traditional Chinese Medicine Hospital, Guangzhou, China.
Orthop Surg. 2025 Apr;17(4):1057-1066. doi: 10.1111/os.14353. Epub 2025 Jan 22.
Treating femoral neck fractures remains a significant challenge for orthopedic surgeons and imposes a substantial economic burden on developing regions. Current novel internal fixation methods demonstrate excellent biomechanical performance. However, these new internal fixation methods are still associated with various complications. This study aimed to report the clinical complications of femoral neck system (FNS) and biplane double-supported screw fixation (BDSF) treatments for femoral neck fractures at our institution and provide directions for selecting cost-effective internal fixation methods.
A retrospective case-control study of adult patients with femoral neck fractures treated with BDSF or FNS was conducted at Nanfang Hospital from April 2019 to April 2022. General medical records were collected both preoperatively and intraoperatively. Primary complication measures included osteonecrosis of the femoral head, nonunion, screw-out, and subtrochanteric fractures, along with femoral neck shortening. The primary functional measure evaluated was the Harris hip score. This study employed t-test, Wilcoxon rank-sum test, and chi-square test to statistically analyze the data.
Statistically significant differences were observed between the BDSF and FNS groups in terms of surgery duration (60.8 ± 12.6 min vs. 71.0 ± 12.0 min), incision length (5.5 ± 1.2 cm vs. 9.1 ± 1.6 cm) and hospitalization costs (39563.8 ± 9086.4 RMB vs. 24960.4 ± 10154.4 RMB). No statistically significant differences between the BDSF and FNS groups were found in the baseline data, blood loss or hospital stay. Moderate femoral neck shortening was significantly less common in the BDSF group than in the FNS group (27.1% vs. 61.5%, p = 0.016). Postoperatively, no statistically significant differences in complication rates, such as femoral head necrosis, nonunion, subtrochanteric fractures or screw-out, were observed between the BDSF and FNS groups.
This study revealed no significant difference in the incidence of postoperative complications such as femoral head necrosis, nonunion or screw cut-out between BDSF and FNS. Although BDSF has drawbacks, such as a long learning curve and the potential to cause subtrochanteric fractures, it is cost-effective and better maintains the length of the femoral neck. The modified BDSF technique may be more suitable for developing regions with limited health care budgets.
治疗股骨颈骨折对骨科医生来说仍然是一项重大挑战，并且给发展中地区带来了沉重的经济负担。目前新颖的内固定方法展现出了出色的生物力学性能。然而，这些新的内固定方法仍伴有各种并发症。本研究旨在报告我院采用股骨颈系统（FNS）和双平面双支撑螺钉固定（BDSF）治疗股骨颈骨折的临床并发症，并为选择具有成本效益的内固定方法提供指导。
2019年4月至2022年4月在南方医院对采用BDSF或FNS治疗的股骨颈骨折成年患者进行了一项回顾性病例对照研究。术前和术中均收集一般医疗记录。主要并发症指标包括股骨头坏死、骨不连、螺钉脱出和转子下骨折，以及股骨颈缩短。评估的主要功能指标是Harris髋关节评分。本研究采用t检验、Wilcoxon秩和检验和卡方检验对数据进行统计学分析。
BDSF组和FNS组在手术时长（60.8±12.6分钟对71.0±12.0分钟）、切口长度（5.5±1.2厘米对9.1±1.6厘米）和住院费用（39563.8±9086.4元对24960.4±10154.4元）方面存在统计学显著差异。BDSF组和FNS组在基线数据、失血量或住院时间方面未发现统计学显著差异。BDSF组中度股骨颈缩短的发生率明显低于FNS组（27.1%对61.5%，p = 0.016）。术后，BDSF组和FNS组在并发症发生率方面，如股骨头坏死、骨不连、转子下骨折或螺钉脱出，未观察到统计学显著差异。
本研究表明，BDSF和FNS在股骨头坏死、骨不连或螺钉切断等术后并发症发生率方面无显著差异。虽然BDSF有缺点，如学习曲线长和可能导致转子下骨折，但它具有成本效益且能更好地保持股骨颈长度。改良的BDSF技术可能更适合医疗保健预算有限的发展中地区。
