加速康复外科理念下应用股骨颈系统和空心螺钉治疗股骨颈骨折的近期疗效比较

目的探讨加速康复外科(ERAS)理念下股骨颈动力交叉钉系统(FNS)和空心螺钉(CCS)固定治疗股骨颈骨折的近期疗效。方法对2019年9月至2021年3月贵州省人民医院急诊外科收治的65例股骨颈骨折患者的临床资料进行回顾性分析。根据内固定方式将全部病例分为FNS组和CCS组。FNS组31例,男14例,女17例,年龄(51.8±12.5)(19~70)岁,左侧15例,右侧16例,骨折Garden分型为Ⅰ型4例、Ⅱ型2例、Ⅲ型16例和Ⅳ型9例。CCS组34例,男16例,女18例,年龄(50.4±12.0)(18~64)岁,左侧19例,右侧15例,骨折Garden分型为Ⅰ型7例、Ⅱ型2例、Ⅲ型22例和Ⅳ型3例。对两组患者围手术期均应用ERAS管理措施。记录两组患者术前等待时间、住院时间、手术时间、术中出血量、术后部分负重时间、术后完全负重时间、骨折愈合时间及并发症发生情况;记录末次随访髋关节Harris评分;记录术前、出院时及末次随访的疼痛视觉模拟评分(VAS)和Barthel指数。结果两组患者术前一般资料及随访时间差异均无统计学意义(均P>0.05),有可比性。FNS组患者的手术时间(46.3±16.6)min、术后部分负重时间(4.1±2.3)周、完全负重时间(8.1±2.7)周和骨折愈合时间(3.3±0.8)个月均显著少于CCS组的(53.0±17.9)min、(6.3±2.6)周、(9.3±2.4)周和(3.9±0.7)个月(均P<0.05)。末次随访时,FNS组患者Harris评分97.0±4.1和Barthel指数97.9±3.1均显著高于CCS组的93.1±5.9和93.2±6.5(均P<0.05)。两组患者住院时间、术中出血量和并发症发生率差异均无统计学意义(均P>0.05)。两组患者术前VAS评分、Barthel指数同出院时及末次随访时差异均有统计学意义(均P<0.05)。结论与CCS固定股骨颈骨折比较,FNS可缩短手术时间和骨折愈合时间,允许患者早期下地活动,促进髋关节功能恢复,提高患者生活质量,更符合ERAS治疗理念。

A comparative study of the short-term effects of femoral neck system and cannulated compression screws in the treatment of femoral neck fracture under the concept of enhanced recovery after surgery

Objective To explore the short-term therapeutic effect of enhanced recovery after surgery(ERAS)in femoral neck fracture managed by femoral neck system and cannulated compression screws.Methods Clinical data of 65 patients with femoral intertrochanteric fracture treated in the Department of Emergency,Guizhou Provincial People's Hospital between September 2019 and March 2021 were analyzed retrospectively.All patients were divided into 2 groups according to their internal fixation modes:the femoral neck system(FNS)group and the cannulated compression screws(CCS)group.There were 31 patients in the FNS group including 14 males and 17 females,with an age of(51.8±12.5)(19-70)years.According to Garden classification,there were 4 cases in typeⅠ,2 cases in typeⅡ,16 cases in typeⅢand 9 cases in typeⅣin the FNS group.There were 34 patients in the CCS group including 16 males and 18 females,with an age of(50.4±12.0)(18-64)years.According to Garden classification,there were 7 cases in typeⅠ,2 cases in typeⅡ,22 cases in typeⅢand 3 cases in typeⅣ.All the patients were additionally adopted the measures of ERAS.The hospitalization time,operation time,intraoperative blood loss,weight-bearing time,fracture healing time,postoperative hospital stay,Harris hip scores and postoperative complication incidence were observed.The VAS score and Barthel index were recorded before operation,at discharged of hospital and in the last follow-up.Results There was no significant difference in preoperative general data or follow-up duration between the 2 groups(all P>0.05).There were significant differences between the FNS group and the CCS group in operation time[(46.3±16.6)min vs.(53.0±17.9)min],partial weight-bearing time[(4.1±2.3)weeks vs.(6.3±2.6)weeks],full weight-bearing time[(8.1±2.7)weeks vs.(9.3±2.4)weeks]and fracture healing time[(3.3±0.8)months vs.(3.9±0.7)months](all P<0.05).Harris hip score and Barthel index of the FNS group at the last follow-up were significantly higher than that of the CCS group(all P<0.05).There were no significant difference in hospitalization time,intraoperative blood loss and incidence of complications between the 2 groups(all P>0.05).The preoperative VAS score and Barthel index of the 2 groups were significant different from that at discharged of hospital(all P<0.05).Conclusion In the treatment of femoral neck fracture,compared with CCS fixation,FNS fixation shortens operation time and fracture healing time,allows patients to ambulate early after operation,promotes recovery of hip function and life quality of patient,and can fulfill the requirement of ERAS.