Jin Yujie, Zhou Xiaoqiang, Li Zhiqiang, Liu Yubo, Xu Renjie, Shen Jun, Zhang Xiangxin, Yu Xiao
Department of Orthopedics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215000, China.
Department of Orthopedics, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated With Soochow University, Suzhou, 215000, China.
BMC Musculoskelet Disord. 2025 Jan 29;26(1):91. doi: 10.1186/s12891-025-08349-w.
To analyze the effects of the positioning of a bolt in the femoral neck system (FNS) on the short-term outcomes of middle-aged and young adults with displaced femoral neck fractures (FNFs).
This was a retrospective study involving 114 middle-aged and young adults with displaced FNFs who were surgically treated with internal fixation via the FNS in the Department of Orthopedics, Suzhou Municipal Hospital, from December 2019 to January 2023. The degree of deviation of the central axis of the femoral head and neck from the tip of the bolt (W), the tip‒apex distance (TAD) and the length of femoral neck shortening (LFNS) were measured on postoperative X-ray and computed tomography (CT) scan images. Clinical efficacy was assessed with the Harris Hip Score (HHS) and the EuroQol five-dimensional questionnaire-5L (EQ-5D-5L) utility index. The enrolled patients were divided into the central group (W ≤ 20%) and deviation group (W > 20%) on the basis of postoperative W value. The quality of fracture reduction, time to postoperative weight-bearing of the affected limb, time to fracture healing, and the TAD, LFNS, HHS and EQ-5D-5L utility index at the last follow-up visit were compared between the groups. Postoperative complications and cases of revision surgery were recorded.
Preoperative baseline characteristics, the quality of fracture reduction, the need for auxiliary reduction and the follow-up time were comparable between the central group and deviation group (all P > 0.05). No significant difference in the time to postoperative partial weight-bearing of the affected limb was detected between the groups (P > 0.05). Patients in the central group presented with a significantly shorter time to full weight-bearing of the affected limb, time to fracture healing, and TAD and LFNS at the last follow-up visit but a greater HHS and EQ-5D-5L utility index than those in the deviation group did (all P < 0.05). The incidence of revision surgery was significantly lower in the central group than in the deviation group (P < 0.05).
Positioning of the FNS bolt closer to the central axis of the femoral head and neck favors a shorter time to fracture healing, greater hip function and a lower incidence of revision surgery in middle-aged and young adults with displaced FNFs.
分析股骨颈系统（FNS）中螺钉位置对中青年移位型股骨颈骨折（FNF）患者短期预后的影响。
本研究为回顾性研究，纳入2019年12月至2023年1月在苏州市立医院骨科接受FNS内固定手术治疗的114例中青年移位型FNF患者。在术后X线和计算机断层扫描（CT）图像上测量股骨头颈中轴线与螺钉尖端的偏差程度（W）、尖顶距（TAD）和股骨颈缩短长度（LFNS）。采用Harris髋关节评分（HHS）和欧洲五维健康量表-5L（EQ-5D-5L）效用指数评估临床疗效。根据术后W值将纳入患者分为中心组（W≤20%）和偏差组（W>20%）。比较两组骨折复位质量、患侧肢体术后负重时间、骨折愈合时间以及末次随访时的TAD、LFNS、HHS和EQ-5D-5L效用指数。记录术后并发症及翻修手术病例。
中心组和偏差组术前基线特征、骨折复位质量、辅助复位需求及随访时间具有可比性（均P>0.05）。两组患侧肢体术后部分负重时间差异无统计学意义（P>0.05）。中心组患者患侧肢体完全负重时间、骨折愈合时间以及末次随访时的TAD和LFNS均显著短于偏差组，而HHS和EQ-5D-5L效用指数则高于偏差组（均P<0.05）。中心组翻修手术发生率显著低于偏差组（P<0.05）。
对于中青年移位型FNF患者，将FNS螺钉置于更靠近股骨头颈中轴线的位置有利于缩短骨折愈合时间，改善髋关节功能，并降低翻修手术发生率。
