摘要
背景:传统内固定方法治疗股骨颈骨折术后并发症发生率较高,不主张早期下地康复和负重。经皮加压钢板是治疗股骨颈骨折新的内固定方法,可以早期下地和负重,中短期随访结果显示骨不连和头坏死等并发症风险并没有增加。目的:探讨股骨颈关节内骨折内固定后是否可早期负重以及增加术后并发症风险。方法:回顾分析2012年1月至2017年12月无锡市第九人民医院收治的股骨颈关节内骨折内固定治疗的患者90例,按内固定方法分为2组,每组45例。空心加压螺钉组采用3枚空心加压螺钉内固定,术后晚期下地负重;经皮加压钢板组以经皮加压钢板内固定,术后早期逐渐负重。观察两组骨折愈合、内固定失败、头坏死和髋关节功能恢复情况(Harris评分);采用多元Logistic回归分析总体并发症与年龄、性别、病程、骨折类型、Pauwel角和内固定方法的关系。结果与结论:①所有患者均随访2年以上;空心加压螺钉组内固定失败5例、不愈合6例、头坏死6例,总体并发症17例;经皮加压钢板组头坏死5例,无内固定失败和不愈合,总体并发症5例;经皮加压钢板组内固定失败、不愈合和总体并发症均少于对照组,差异有显著性意义(P=0.011,0.021,0.006);空心加压螺钉组头坏死发生时间较经皮加压钢板组早;末次随访两组头坏死发生情况差异无显著性意义(P=0.748);②术后6,12个月经皮加压钢板组髋关节功能恢复优于空心加压螺钉组,差异均有显著性意义(P=0.000,0.001),但术后24个月和末次随访两组髋关节功能恢复比较差异无显著性意义(P=0.174,0.285);③多元Logistic回归分析显示,内固定方法是唯一具有统计学意义的并发症风险因素,经皮加压钢板组总体并发症的发生概率比空心加压螺钉组降低了73.9%(OR=0.261,P=0.034);④提示与股骨颈关节内骨折内固定术后并发症有关的影响因素是内固定器性能本身,而不是术后早期负重;具有可靠稳定性、而且具有滑动加压性能的内固定器才是减少术后并发症风险的关键因素。
BACKGROUND:Traditional internal fixation has a high incidence of postoperative complications in the treatment of femoral neck fractures,and early rehabilitation and weight-bearing are not advocated.Percutaneous compression plate is a new internal fixation method for the treatment of femoral neck fractures,which allows early rehabilitation and weight-bearing.The short and medium-term follow-up results showed that the risk of complications such as nonunion and head necrosis did not increase.OBJECTIVE:To investigate whether early postoperative weight-bearing after internal fixation of intracapsular femoral neck fractures may be taken and increases the risk of postoperative complications.METHODS:From January 2012 to December 2017,90 patients with intracapsular femoral neck fractures undergoing internal fixation in the Wuxi No.9 People’s Hospital were retrospectively studied.According to the methods of internal fixation,they were divided into two groups,and each group had 45 cases.Hollow compression screws group was fixed with three hollow compression screws and taking late weight-bearing.The percutaneous compression plate group was fixed with percutaneous compression plate and taking early gradual weight-bearing.Fracture healing,internal fixation failure,head necrosis,and hip functional recovery(Harris score)were observed in both groups.Internal fixation failure,nonunion,and head necrosis were considered as overall complication.Multivariate Logistic regression was used to analyze the relationship between overall complication and age,sex,course of disease,fracture type,Pauwel angle and internal fixation method.RESULTS AND CONCLUSION:(1)All patients were followed-up for more than 2 years.There were 5 cases of internal fixation failure,6 cases of nonunion,6 cases of head necrosis and 17 cases of overall complication in hollow compression screws group;while 5 cases of head necrosis,and 5 cases of overall complication without internal fixation failure or nonunion in percutaneous compression plate group.The internal fixation failure,nonunion and overall complication in percutaneous compression plate group were significantly lower than those in hollow compression screws group(P=0.011,0.021,0.006).The head necrosis occurred earlier in hollow compression screws group than that in percutaneous compression plate group.In terms to the head necrosis rate,there was no significant difference in the final follow-up between the two groups(P=0.748).(2)The hip functional recovery in percutaneous compression plate group was better than that in hollow compression screws group at 6 and 12 months postoperatively(P=0.000,0.001).However,there were no significant differences at 24 months and the last follow-up between the two groups(P=0.174,0.285).(3)Multiple Logistic Regression analysis showed that internal fixation method was the only statistically significant risk factor for overall complication.Probability of occurrence of overall complication was reduced by 73.9%in percutaneous compression plate group than that in hollow compression screws group(OR=0.261,P=0.034).(4)It is the performance of the internal fixator,not the early postoperative weight-bearing,which is related to the postoperative complications of intra-articular femoral neck fractures;the key factor to reduce the risk of postoperative complications is the reliable stable internal fixator with sliding compression effect.
作者
李海峰
刘宇
殷渠东
孙振中
芮永军
顾三军
Li Haifeng;Liu Yu;Yin Qudong;Sun Zhenzhong;Rui Yongjun;Gu Sanjun(Department of Orthopedics,Wuxi No.9 People’s Hospital,Wuxi 214062,Jiangsu Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2021年第18期2875-2880,共6页
Chinese Journal of Tissue Engineering Research
关键词
股骨
股骨颈骨折
空心加压螺钉
经皮加压钢板
内固定
早期负重
并发症
femur
femoral neck fracture
hollow compression screws
percutaneous compression plate
internal fixation
early weight-bearing
complications
