Objective To compare the curative effect and biomechanical performance of cannulated compression screw (CCS) and dynamic hip screw-blade (DHS-B) in the treatment of patients with femoral neck fracture.Methods Between February 2010 and February 2014,102 patients with femoral neck fracture were treated with CCS or DHS-B at our department.They were 54 males and 48 females,aged from 15 to 86 years.There were 30 subcapital fractures,51 transcervical ones and 21 base ones.CCS was used in 60 patients and DHS-B in 42.In-hospital data were collected retrospectively to compare the curative effects in 2 groups.Furthermore,femoral neck fracture models were established using 12 adult cadaveric femoral specimens.The 12 models were randomized into 2 equal groups (n =6).Group A was subjected to fixation by 3 CCSs and group B to fixation by DHS-B.The 2 groups were compared in terms of axial loading test,rotation test and destructive axial loading test.Results The operation time (59.4 ± 20.2 min),incision size (4.1 ±0.6 cm) and intraoperative blood loss (25.9 ±9.9 mL) in the CCS group were significantly less than those in the DHS-B group (88.6±22.9 min,12.1 ±1.2cmand 156.7±107.1 mL) (P ＜0.05).The Harris hip score for the DHS-B group (91.9±9.8) was significantly higher than that for the CCS group (87.2 ± 9.2) (P ＜ 0.05).There were no significant differences between the 2 groups in hospital stay,partial weight-bearing time,or postoperative complications (P ＞ 0.05).At 500 N vertical loading,the stress values at both medial and lateral sides of the femur in group A were significantly smaller than those in group B (P ＜ 0.05).There were no significant differences between groups A and B in the average sinking displacement of femoral head or the torque at a torsion angle of 6° (P ＞ 0.05).The maximum load in group A (2,135 ±120 N) was significantly smaller than that in group B (2,986 ± 98 N) (P ＜ 0.05).Conclusion In treatment of femoral neck fracture,DHS-B fixation is obviously superior to CCS fixation,because the former is in better agreement with the femoral biomechanical property,and performs better in anti-rotation and anti-compression,leading to better functional recovery of the affected hip.%目的 比较空心加压螺钉(CCS)与动力髋螺钉螺旋刀片(DHS-B)治疗股骨颈骨折的临床疗效及生物力学性能. 方法 回顾性分析2010年2月至2014年2月期间采用CCS或DHS-B治疗的102例股骨颈骨折患者资料,男54例,女48例;年龄为15～86岁;骨折类型:头下型30例,经颈型51例,基底型21例.根据内固定方式不同分为2组:CCS组60例,DHS-B组42例.比较2组患者的疗效.选取12具成人尸体股骨标本,制成股骨颈骨折模型,随机分为2组(n=6):A组采用3枚CCS固定,B组采用DHS-B固定,进行轴向载荷试验、水平扭转试验及轴向加压破坏试验. 结果 CCS组患者的手术时间[(59.4±20.2) min]和切口长度[(4.1 ±0.6)cm]显著短于DHS-B组患者[(88.6±22.9)min、(12.1±1.2) cm],术中出血量[(25.9±9.9) mL]显著少于DHS-B组患者[(156.7±107.1)mL],末次随访时髋关节Harris评分[(87.2±9.2)分]显著低于DHS-B组患者[(91.9±9.8)分],差异均有统计学意义(P＜0.05).两组患者的住院时间、部分负重时间及术后并发症发生率等比较差异均无统计学意义(P＞0.05).载荷为500 N时,无论是股骨内侧还是外侧,A组的应变值均显著大于B组,差异有统计学意义(P＜0.05).而A组与B组的股骨头下沉位移和扭角为6°时的扭矩比较差异均无统计学意义(P＞0.05).A组最大载荷[(2 135±120) N]显著小于B组[(2 986±98)N],差异有统计学意义(P＜0.05).结论 DHS-B固定股骨颈骨折更符合股骨的生物力学特性,具有良好的防旋和抗压能力,患者髋关节功能恢复良好,较CCS具有明显优势.
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