Objective: To compare the effectiveness of biplanar vertical fixation and inverted triangle fixation with hollow screw for Pauwels type Ⅲ femoral neck fracture in young and middle-aged patients.
Methods: The clinical data of 55 young and middle-aged patients with Pauwels type Ⅲ femoral neck fracture between June 2021 and December 2022 was retrospectively analyzed. All patients were treated with closed reduction and internal fixation with hollow screws, 25 cases were treated with biplanar vertical fixation (study group), 30 cases with inverted triangle fixation (control group). There was no significant difference in gender, age, affected side, cause of injury, underlying diseases, and time from injury to operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, fluoroscopy times, guide needle puncture times, starting time of weight bearing, time of full weight bearing, time of fracture healing, and complications were recorded and compared between the two groups. The hip joint function was evaluated by Harris score at 1 day, 6 months, 12 months after operation, and at last follow-up, and the pain relief was evaluated by visual analogue scale (VAS) score. The femoral neck shortening was measured on the X-ray film at last follow-up.
Results: All patients were followed up 12-31 months (mean, 22.0 months), and there was no significant difference in follow-up time between the two groups ( P>0.05). The operation time, intraoperative blood loss, and fluoroscopy times in the study group were higher than those in the control group, but the difference was not significant ( P>0.05). The guide needle puncture times in the study group was more than that in the control group, and the time of starting weight bearing and the time of full weight bearing in the study group were shorter than those in the control group, the differences were significant ( P<0.05). Bony healing was achieved in both groups, and there was no significant difference in fracture healing time between the two groups ( P>0.05). No osteonecrosis of the femoral head and incision-related complication was found in the two groups during follow-up, and the femoral neck shortening length in the study group was significantly shorter than that in the control group at last follow-up ( P<0.05). There was no significant difference in Harris score between the two groups at 1 day after operation ( P>0.05), and the Harris score of the study group was significantly better than that of the control group at other time points ( P<0.05); there was no significant difference in VAS score between the two groups at each time point after operation ( P>0.05).
Conclusion: Compared with the inverted triangle fixation, the treatment of Pauwels type Ⅲ femoral neck fracture with biplanar vertical fixation can effectively reduce femoral neck shortening without affecting fracture healing, and improve hip joint function in early stage.
目的: 比较空心螺钉双平面垂直固定与倒三角固定治疗中青年Pauwels Ⅲ型股骨颈骨折的临床疗效。.
方法: 回顾分析2021年6月—2022年12月收治且符合选择标准的55例中青年Pauwels Ⅲ型股骨颈骨折患者临床资料。均采用闭合复位空心螺钉治疗，25例采用双平面垂直固定（研究组），30例采用倒三角固定（对照组）。两组患者性别、年龄、患侧侧别、致伤原因、合并基础疾病、受伤至手术时间等基线资料比较差异均无统计学意义（ P>0.05）。记录并比较两组手术时间、术中出血量、透视次数、导针穿刺次数、开始负重时间、完全负重时间、骨折愈合时间及并发症发生情况；术后1 d、6个月、12个月及末次随访时，采用Harris评分评价髋关节功能，疼痛视觉模拟评分（VAS）评价疼痛缓解情况。末次随访时于X线片上测量股骨颈短缩长度。.
结果: 两组患者均获随访，随访时间12～31个月，平均22.0个月；两组随访时间比较差异无统计学意义（ P>0.05）。研究组手术时间、术中出血量、透视次数均多于对照组，但差异无统计学意义（ P>0.05）；研究组导针穿刺次数多于对照组，开始负重时间及完全负重时间均短于对照组，差异有统计学意义（ P<0.05）；两组患者均获骨性愈合，骨折愈合时间差异无统计学意义（ P>0.05）。随访期间两组均未发生股骨头坏死及切口相关并发症，末次随访时研究组股骨颈短缩长度明显短于对照组（ P<0.05）。除术后1 d两组Harris评分比较差异无统计学意义（ P>0.05）外，其余时间点研究组Harris评分均优于对照组（ P<0.05）；术后各时间点两组VAS评分比较差异均无统计学意义（ P>0.05）。.
结论: 与倒三角固定相比，利用空心螺钉双平面垂直固定治疗中青年Pauwels Ⅲ型股骨颈骨折能有效减少股骨颈短缩且不影响骨折愈合，早期恢复髋关节功能，临床疗效肯定。.
Keywords: Femoral neck fracture; biplanar vertical fixation; hollow screw; internal fixation; inverted triangle fixation; young and middle-aged.