Abstract:

Objective　To observe the effects of different hollow nail distribution techniques in open reduction and internal fixation for patients with femoral neck fractures and the influence on hip joint function and fracture healing. Methods　One hundred and twenty patients with femoral neck fractures admitted to Xinyang 154th Hospital from May 2021 to May 2022 were selected for the randomized controlled trial. The patients were divided into group A and group B by lottery, with 60 cases in each group. There were 32 males and 28 females in group A; they were (55.26±5.17) years old; the fracture course was 2-14 (8.33±0.21) d; there were 27 cases of type Ⅰ and Ⅱ and 33 cases of type Ⅲ and Ⅳ of Garden fracture typing. There were 30 males and 30 females in group B; they were (55.31±5.22) years old; the fracture course was 3-13 (8.35±0.16) d; there were 25 cases of type Ⅰ and Ⅱ and 35 cases of type Ⅲ and Ⅳ of Garden fracture typing. Group A took the fixation by traditional parallel nails, and group B by F shape hollow nails. The surgical conditions, postoperative hip joint function recovery, fracture healing within 3 months after surgery, and postoperative complications were compared between the two groups. t and χ² tests were used. Results　There were no statistical differences in the surgical time, intraoperative bleeding volume, and intraoperative irradiation time between the two groups (all P>0.05). Before the surgery, there were no statistical differences in the scores of pain, function, malformation, and joint movement range between the two groups (all P>0.05). After the surgery, the scores of pain, function, malformation, and joint movement range in group B were higher than those in group A [(38.74±0.82) vs. (38.41±0.25), (40.56±0.83) vs. (40.27±0.22), (3.57±0.88) vs. (3.25±0.31), and (3.61±0.85) vs. (3.36±0.25)], with statistical differences (t=2.982, 2.616, 2.657, and 2.186; all P<0.05). Under different fixation techniques, the fracture healed rate within 3 months after the surgery and the fracture healing time in group B were better than those in group A [86.67% (52/60) vs. 68.33% (41/60) and (4.25±0.31) months vs. (4.58±0.86) months], with statistical differences (χ²=5.175; t=2.796; both P<0.05). The incidence of postoperative complications of group B was lower than that of group A [6.67% (4/60) vs. 8.33% (11/60)], with a statistical difference (χ²=6.215; P=0.013). Conclusion　Compared with traditional parallel nails, the application of F shape hollow nails in open reduction and internal fixation for patients with femoral neck fractures has better effect, and is of positive significance in promoting their recovery of hip joint function, accelerating the process of fracture healing, and reducing the risk of postoperative complications.

Key words:

Femoral neck fractures, Open reduction and internal fixation, Hollow nails, Parallel nails, Hip joint function

摘要：

目的　观察不同空心钉分布技术在股骨颈骨折切开复位内固定术中的应用效果及对患者髋关节功能、骨折愈合情况的影响。方法　开展前瞻性随机对照试验。选取2020年5月至2021年5月信阳一五四医院收治的120例股骨颈骨折患者作为研究对象，采用抽签法分为A组和B组，各60例。A组男32例、女28例，年龄（55.26±5.17）岁，骨折病程2～14（8.33±0.21）d，Garden骨折分型：Ⅰ～Ⅱ型27例、Ⅲ～Ⅳ型33例，采用传统平行钉固定；B组男30例、女30例，年龄（55.31±5.22）岁，骨折病程3～13（8.35±0.16）d，Garden骨折分型：Ⅰ～Ⅱ型25例、Ⅲ～Ⅳ型35例，应用F形空心钉固定。对比两组患者手术情况、术后髋关节功能恢复情况、术后3个月内骨折愈合及术后并发症发生情况。统计学方法采用t检验、χ²检验。结果　两组患者手术时间、术中出血量、术中照射时间比较，差异均无统计学意义（均P>0.05）。治疗前，两组患者疼痛、功能、畸形、关节活动度评分比较，差异均无统计学意义（均P>0.05）；治疗后，B组疼痛、功能、畸形、关节活动度评分均高于A组［（38.74±0.82）分比（38.41±0.25）分、（40.56±0.83）分比（40.27±0.22）分、（3.57±0.88）分比（3.25±0.31）分、（3.61±0.85）分比（3.36±0.25）分］，差异均有统计学意义（t=2.982、2.616、2.657、2.186，均P<0.05）。在不同治疗方案下，B组术后3个月内骨折愈合率高于A组［86.67%（52/60）比68.33%（41/60）］，骨折愈合时间短于A组［（4.25±0.31）个月比（4.58±0.86）个月］，差异均有统计学意义（χ²=5.175，t=2.796；均P<0.05）。B组术后并发症发生率为6.67%（4/60），低于A组的18.33%（11/60），差异有统计学意义（χ²=6.215，P=0.013）。结论　与传统平行钉固定相比，在股骨颈骨折切开复位内固定术中应用F形空心钉固定效果较好，对促进患者术后髋关节功能恢复、加快骨折愈合进程、降低术后并发症发生风险均有积极意义。

关键词:

股骨颈骨折, 切开复位内固定术, 空心钉, 平行钉, 髋关节功能