动态髋螺钉系统与去旋转髋螺钉对比治疗股骨颈骨折

Shantonu Kumar Saha, H. M. Hira, Jabed Jahangir, Ajoy Deb, Mamun Mustafa, S. Ghosh
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摘要

背景:股骨颈骨折即使采用最好的固定方法和适当的复位,也会导致股骨头不愈合和骨坏死,一直是骨科医生面临的巨大挑战。股骨颈骨折的治疗根据患者的年龄和骨折类型不同而不同。本研究的目的是比较带侧板去旋转螺钉的DHS与多枚空心髋螺钉治疗成人股骨颈骨折的疗效。材料与方法:本准实验研究于2017年7月至2019年6月在吉大港医学院附属医院骨科进行。60例年龄在18 - 55岁之间的(AO/OTA 31-B)骨折患者,按照设定的标准,采用有目的的抽样技术,采用DHS联合侧钢板和去旋转螺钉或空心髋螺钉进行治疗。Harris髋关节评分用于评估手术的功能结局。结果:本组60例患者中,男性(83%)多于女性(17%),26 ~ 36岁年龄组发病率最高(30%),累及左侧51.7%,右侧48.3%。超过60%的病例是RTA所致。Harris髋关节评分显示,DHS联合去旋转螺钉组的功能结果为68%优,24%优,空心螺钉组的功能结果为55.6%优,25.9%优。DHS去旋转螺钉组软组织感染6.7%,深部感染13.3%,延迟愈合,骨不连及髋关节僵硬10%,AVN 6.7%;空心螺钉组软组织感染10%,深部感染6.7%,延迟愈合,骨不连及髋关节僵硬13.33%,AVN 10%。固定螺钉组放射愈合时间平均±SD为12.5±1.225周,空心螺钉组放射愈合时间平均±SD为13.61±1.559周。结论:成人股骨颈骨折用DHS联合去旋转螺钉固定功能优于空心螺钉固定。Jcmcta 2022;33 (1): 112-117
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Femoral Neck Fracture Treated with Dynamic Hip Screw System with De-rotation Screw Versus Cannulated Hip Screws
Background: Fracture neck of femur has always presented a great challenge to orthopedic surgeons due to its nature of going into non-union and osteonecrosis of femoral head even with the best fixation method and adequate reduction. Treatment of fracture neck of femur varies according to patient’s age and fracture pattern. Purpose of this study was to compare the outcome of DHS with side plate and de-rotation screw with multiple cannulated hip screws in fracture neck of femur in adult. Materials and methods: This quasi-experimental study was carried out in the Department of Orthopedic Surgery, Chittagong Medical College Hospital from July 2017 to June 2019. Sixty patients age limit between 18 to 55 years, with (AO/OTA 31-B) fracture was taken by purposive sampling technique as per set criteria and were treated either by DHS with side plate and de-rotation screw or by cannulated hip screws. Harris Hip Score was used for evaluation of functional outcome of surgery.   Results: In this study, out of 60 patients, male (83%) were more than female (17%), maximum age incidence was found in 26-36 years age group (30%), left side involvement was 51.7% and right side was 48.3%. Over 60% incidence was due to RTA. Functional outcome was 68% excellent and 24% good in DHS with de-rotation screw group and 55.6% good and 25.9% excellent in cannulated hip screw group according to Harris Hip Score. Only 6.7% had soft tissue infection, 13.3% had deep seated infection and delayed union, 10% had non-union and hip stiffness and 6.7% had AVN in DHS with de- rotation screw group and 10% had soft tissue infection, 6.7% had deep seated infection and delayed union, 13.33% had non-union and hip stiffness and 10% had AVN in cannulated hip screw group. Mean ± SD radiological union time in DHS with de-rotation screw group was 12.5 ± 1.225 weeks and in cannulated hip screw group was 13.61 ± 1.559 weeks. Conclusion: The functional outcome of fixation by DHS with de-rotation screw was better than fixation by cannulated hip screw for femoral neck fracture in adults. JCMCTA 2022 ; 33 (1) : 112-117
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