Lucenti Ludovico, Sodano Andrea, Panvini Flora Maria Chiara, Vescio Andrea, Papotto Giacomo, Testa Gianluca, Pavone Vito
Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy.
Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90133 Palermo, Italy.
J Clin Med. 2025 Aug 21;14(16):5917. doi: 10.3390/jcm14165917.
: Femoral neck fractures are a growing concern due to their increasing incidence in both elderly and younger populations. Preoperative CT scan evaluation is often used for better understanding of fracture patterns of femoral neck fractures that need to be treated using cannulated screws. : The present study retrospectively analyzed 55 patients treated with cannulated screw fixation over seven years. Preoperative CT scans, fracture classification (Garden and Pauwels), and surgical timing were evaluated. : All 55 patients were treated with three cannulated screws by nine fellowship-trained surgeons. The average age of the CT-yes group was 54.44 years (SD 15.45), while the average age of the CT-no group was 56.93 (SD 14.95). Differences in age among the two groups were not statistically significant. In 4 patients, the treatment with cannulated screws failed, leading to a subsequent total hip arthroplasty for avascular necrosis (AVN). Three of them belonged to the CT-yes group, while only one belonged to the CT-no group. A statistical analysis showed no significant differences between patients who underwent a CT scan and those who did not have a CT scan and their results ( = 0.282). Results indicate no statistically significant difference in outcomes between patients who underwent a CT scan before the surgical treatment and those who did not, while a well-conducted X-ray assessment is essential and can be sufficient to fully understand and treat most of the fractures. : The risks of avascular necrosis and non-union must be considered in the decision-making process regarding the suitable treatment. Early surgery did not significantly improve treatment results, but it is recommended. Fixation with cannulated screws remains a good treatment, especially for some patterns of fractures and younger patients. Given the study's limitations, including the small sample size and retrospective nature, prospective multicenter studies are warranted to better understand the role of CT scans in optimizing surgical planning and improving patient outcomes.
由于股骨颈骨折在老年和年轻人群中的发病率不断上升，其日益受到关注。术前CT扫描评估常用于更好地了解需要使用空心螺钉治疗的股骨颈骨折的骨折类型。本研究回顾性分析了7年间接受空心螺钉固定治疗的55例患者。评估了术前CT扫描、骨折分类（Garden和Pauwels）以及手术时机。所有55例患者均由9名接受过专科培训的外科医生用3枚空心螺钉进行治疗。CT检查阳性组的平均年龄为54.44岁（标准差15.45），而CT检查阴性组的平均年龄为56.93岁（标准差14.95）。两组之间的年龄差异无统计学意义。4例患者空心螺钉治疗失败，随后因股骨头缺血性坏死（AVN）接受了全髋关节置换术。其中3例属于CT检查阳性组，而只有1例属于CT检查阴性组。统计分析显示，接受CT扫描的患者与未接受CT扫描的患者及其结果之间无显著差异（P = 0.282）。结果表明，手术治疗前接受CT扫描的患者与未接受CT扫描的患者在治疗结果上无统计学显著差异，而进行良好的X线评估至关重要，并且足以充分了解和治疗大多数骨折。在关于合适治疗的决策过程中，必须考虑股骨头缺血性坏死和不愈合的风险。早期手术并未显著改善治疗结果，但仍建议进行。空心螺钉固定仍然是一种良好的治疗方法，特别是对于某些骨折类型和年轻患者。鉴于该研究的局限性，包括样本量小和回顾性研究性质，有必要进行前瞻性多中心研究，以更好地了解CT扫描在优化手术规划和改善患者预后中的作用。
