经皮加压钢板与空心加压螺钉治疗股骨颈骨折的比较

摘要

目的 比较经皮加压钢板(percutaneous compression plate,PCCP)与空心加压螺钉治疗股骨颈骨折的疗效.方法 2010年1月~2015年2月90例符合内固定治疗的股骨颈骨折分别采用PCCP(试验组,n=45)或3枚空心加压螺钉固定(对照组,n=45).比较手术时间、术中出血量、骨折复位质量、骨折愈合时间、术后下地康复时间、完全负重时间、并发症情况和髋关节功能恢复(Harris评分).结果 对照组手术时间(62.1±19.6)min,明显短于试验组(81.4±11.2)min(t=5.735,P=0.000);对照组术中出血量(75.4±11.1)ml,明显短少于试验组(97.7±12.1)ml(t=9.110,P=0.000).2组骨折复位质量无统计学差异(χ2=0.359,P=0.949).试验组骨折愈合时间(5.2±0.7)月,明显短于对照组(6.4±0.8)月(t=-7.573,P=0.000);试验组并发症4例,明显少于对照组11例(χ2=3.920,P=0.048);试验组下地康复时间中位数8 d(3~45 d),明显短于对照组中位数40 d(16~68 d)(Z=-7.928,P=0.000);试验组完全负重时间(3.1±0.7)月,明显短于对照组(5.7±0.6)月(t=-18.918,P=0.000).90例随访(23.1±3.5)月,末次随访试验组Harris评分(89.7±11.9)分,明显高于对照组(82.2±10.8)分(t=3.131,P=0.002).结论 与空心加压螺钉相比,PCCP治疗股骨颈骨折尽管手术时间较长、创伤较大,但具有更好的静态稳定性和动态滑动加压作用,术后可早期下地康复,并发症更少,功能恢复更好.%Objective To compare the effectiveness between percutaneous compression plate ( PCCP ) and hollow compression screws for the treatment of femoral neck fractures . Methods From January 2010 to February 2015, 90 cases of femoral neck fractures indicated for internal fixation were divided into either experimental group ( treated with PCCP, 45 cases) or control group ( treated with 3 hollow compression screws , 45 cases ) .The operation time , intraoperative blood loss , reduction quality , fracture healing time, postoperative rehabilitation time out of bed, weight-loading time, complications, and hip functionary recovery (Harris score) were compared. Results The operation time in the control group (62.1 ±19.6 min) was significantly less than that in the experimental group [(81.4 ±11.2) min, t=5.735, P=0.000], and the intraoperative blood loss in the control group (75.4 ±11.1 ml) was significantly less than that in the experimental group [(97.7 ±12.1) ml, t=9.110, P=0.000].There was no significant difference in the reduction quality (χ2 =0.359, P=0.949).The fracture healing time in the experimental group (5.2 ±0.7 months) was significantly shorter than that in the control group [(6.4 ±0.8) months, t =-7.573, P=0.000],the complications in the experimental group (4 cases) were significantly less than that in the control group (11 cases, χ2 =3.920, P=0.048), the median rehabilitation time out of bed in the experimental group (8 d) was significantly shorter than that in the control group (40 d, Z=-7.928, P=0.000), and the weight-loading time in the experimental group (3.1 ±0.7 months) was significantly shorter than that in the control group [(5.7 ±0.6) months, t=-18.918, P=0.000].The follow-up time was (23.1 ±3.5) months.And the Harris scores at the last follow-up were significantly higher in the experimental group (89.7 ±11.9) points than that in the control group [(82.2 ±10.8) points, t=3.131, P=0.002]. Conclusion As compared with the hollow screw fixation, PCCP has better static stability and dynamic sliding pressure effect , early postoperative rehabilitation , less complications and better functional recovery for the treatment of femoral neck fractures , despite longer operation time and larger trauma .