目的：观察空心钉锁定钢板与加压空心螺钉治疗青壮年股骨颈骨折的临床疗效。方法回顾性分析医院2009年1月至2012年8月分别采用空心钉锁定钢板（A 组，n =25）和加压空心螺钉（B 组，n =32）治疗的青壮年股骨颈骨折患者。A 组中，男16例，女9例，年龄17~54岁，平均36.4岁；Garden Ⅰ，Ⅱ，Ⅲ，Ⅳ型分别为1，4，11，9例；B 组中男20例，女12例，年龄21~59岁，平均39.6岁；Garden Ⅰ，Ⅱ，Ⅲ，Ⅳ型分别为3，6，13，10例。记录并比较两组患者的手术时间、手术出血量、住院时间、术后12个月 Harris 功能评分、内固定松动与退钉比率、骨折不愈合及股骨头坏死发生率。结果 A 组、B 组患者的手术时间分别为（45.9±16.4）min 和（53.2±18.1） min，术中出血量分别为（75.5±13.8）mL 和（29.7±10.2）mL，住院时间分别为（9.5±1.6）d 和（10.1±1.4）d，术后12个月髋关节 Har-ris 评分分别为（78.4±13.2）分和（83.7±11.9）分，骨折不愈合及股骨头坏死率分别为16.00%和15.63%。上述指标中除术中出血量差异有统计学意义外（ P ﹤0.05），其余指标差异均无统计学意义；内固定松动比率分别为8.00%和31.25%，差异有统计学意义（ P ﹤0.05）；二次手术取出困难的比率分别为0和21.88%，差异有统计学意义（ P ﹤0.05）。结论空心钉锁定板与加压空心螺钉在治疗青壮年股骨颈骨折均可提供良好的固定作用，空心钉锁定钢板具有松动、退钉率低、二次取出更容易等优势。两者在骨折不愈合及股骨头坏死发生率上无统计学差异。%Objective To compare the clinical efficacy of the hollow screw locking plate and the hollow compression screw for treating femoral neck fracture in young adults. Methods The young adult patients with femoral neck fracture in our hospital from January 2009 to August 2012 were treated by the hollow screw locking plate(group A,n = 25) and the hollow compression screw(group B,n = 32) respectively. The group A adopted the hollow screw locking plate (16 males, 9 females, mean age 36. 4 years; aged 17 - 54 years; the Garden typeⅠ, Ⅱ, Ⅲ, Ⅳ fractures were 1, 4, 11 and 9 cases, respectively; The group B adopted the hollow compression screw (20 males, 12 females; aged 21 - 59 years; mean age 39. 6 years, the Garden typeⅠ, Ⅱ, Ⅲ, Ⅳfractures were 3, 6, 13 and 10 cases respectively. The operative time, blood loss, hospital stay, the Harris functional score, internal fixation losening and the ratio of screw withdraw as well as the occurrence rate of nonunion and femoral head necrosis within postoperative 12 months were observed and compared. Results The operative time of the two groups were (45. 9 ± 16. 4)min and (53. 2 ± 18. 1)min, the hospital stay was (9. 5 ± 1. 6)d and (10. 1 ± 1. 4) d, the Harris Score was (78. 4 ± 13. 2) and (83. 7 ± 11. 9) and the occurrence rate of nonunion and femoral head necrosis was 16. 00%and 15. 63% , the above differences between the two groups had no statistical significance, but the intraoperative blood loss in the two groups was (75. 5 ± 13. 8) mL and (29. 7 ± 10. 2) mL respectively, the difference between them had statistical significance( P ﹤ 0. 05); the ratio of internal losening was 8. 00% and 31. 25% respectively, the difference between the two groups showing statistical difference ( P ﹤ 0. 05 ) ; the ratio of implant removing difficulty was 0 and 21. 88% respectively, the difference between the two groups showing statistical difference( P ﹤ 0. 05). Conclusion The hollow screw locking plate and the hollow compression screw for treating femoral neck fracture in young adults all provide better fixation effect, but the hollow screw locking plate has the superiority of low ratio of losening and screw withdraw, easier second removal. The occurrence rate of nonunion and femoral head necrosis has no statistical difference be-tween the two methods.
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