【摘要】 目的 探究股骨颈后皮质破坏对内固定术后疗效影响。方法 回顾性分析2018年8月—2021年9月阜阳市人民医院骨科收治的行手术治疗青壮年移位型股骨颈骨折患者89例，男性46例，女性43例；年龄18～59岁，平均46.8岁。根据股骨颈后皮质是否破坏分为观察组(50例)和对照组(39例):观察组为移位合并后皮质破坏的股骨颈骨折患者，其中采用股骨颈系统(femoral neck system, FNS)固定19例，采用3枚空心加压螺钉(cannulated compression screw, CCS)固定31例；对照组为移位但无后皮质破坏的股骨颈骨折患者，采用FNS固定17例，采用CCS固定22例。比较两组患者骨折愈合时间、术后完全负重时间、术后3、6个月随访时髋关节Harris评分及末次随访时并发症发生情况。结果 两组患者均获6～40个月随访，平均17.4个月。观察组术后完全负重时间、骨折愈合时间均多于对照组[(18.08±4.52)周vs.(15.28±4.67)周，(4.52±1.13)个月vs.(3.74±1.12)个月，P<0.05];术后3、6个月Harris评分均低于对照组[(81.36±2.95)分vs.(83.74±2.41)分，(90.46±3.55)分vs.(92.87±2.36)分，P<0.05]。观察组中采用FNS固定术后完全负重时间、骨折愈合时间均少于采用CCS固定[(14.74±2.33)周vs.(18.84±4.52)周，(3.68±0.58)个月vs.(4.71±1.13)个月];采用FNS固定术后3、6个月Harris评分均高于采用CCS固定[(83.26±1.48)分vs.(80.19±3.04)分，(92.68±1.86)分vs.(89.71±3.86)分，P<0.05]。两组患者随访期间均未发生内固定断裂、松动并发症，术后股骨头缺血性坏死发生率比较差异有统计学意义(P<0.05),股骨颈短缩和骨不连发生率比较差异均无统计学意义(P>0.05)。观察组中采用FNS和CCS固定后股骨颈短缩、骨不连和股骨头缺血性坏死的发生率比较差异均无统计学意义(P>0.05)。结论 后皮质破坏增加了青壮年移位型股骨颈骨折术后股骨头缺血性坏死的风险；与CCS相比，FNS固定治疗青壮年股骨颈骨折可缩短骨折愈合时间，并允许患者术后早期下床负重，有利于髋关节功能的恢复。更多还原

【Abstract】 Objective To explore the effect of destruction of the posterior cortex in femoral neck fractures after internal fixation. Methods A retrospective analysis was performed on 89 young adults with displaced femoral neck fractures who received surgery in the Department of Orthopedics of Fuyang People’s Hospital from Aug. 2018 to Sep. 2021. There were 46 males and 43 females with mean age of 46.8 years, range 18-59 years. The patients were divided into two groups according to whether the posterior cortex of the femoral neck was damaged(observation group, n=50) or not(control group, n=39). In the observations, 19 patients were fixed by femoral neck system(FNS) and 31 by three cannulated compression screws(CCS); while in the control group, 17 cases were fixed by FNS and 22 by CCS. The fracture healing time, postoperative full weight bearing time, hip joint Harris score at postoperative 3 and 6 months and complications at the last follow-up were compared between two groups. Results Patients in both groups were followed up for 6-40 months, mean 17.4 months. Compared with control group, the observation group required significantly longer duration for complete weight-bearing(weeks, 18.08±4.52 vs. 15.28±4.67) and fracture healing(months, 4.52±1.13 vs. 3.74±1.12,both P<0.05),and much lower Harris score at postoperative 3 months(81.36±2.95 vs. 83.74±2.41) and 6 months(90.46±3.55 vs. 92.87±2.36,both P<0.05). Within the observation group, FNS fixation showed a much shorter duration of complete weight-bearing(weeks, 14.74±2.33 vs. 18.84±4.52) and fracture healing(months, 3.68±0.58 vs. 4.71±1.13),as well as significantly higher Harris score at postoperative 3 months(83.26±1.48 vs. 80.19±3.04) and 6 months(92.68±1.86 vs. 89.71±3.86),compared with CCS fixation(all P<0.05). No internal fixator breakage or loosening was reported during follow-up for all the patients. Statistically significant difference was observed between two groups in the incidence of postoperative avascular necrosis of the femoral head(P<0.05),but not in the incidence of femoral shortening or bone nonunion(both P>0.05); all the three complications were not significantly different between FNS and CCS fixations within the observation group(P>0.05). Conclusion Posterior cortical destruction increases the risk of avascular necrosis of the femoral head after displaced femoral neck fractures in young adults. Compared with CCS,FNS fixation can shorten the fracture healing time and allow early weight bearing exercises after surgery, which is conducive to hip function recovery in young patients with femoral neck fractures.更多还原