Observation On The Clinical Effect Of DAA Approach Hollow Screw Combined With Plate Internal Fixation In The Treatment Of Garden Ⅲ And Ⅳ Femoral Neck Fractures

Objective:To observe the clinical efficacy of direct anterior approach(DAA)hollow nails combined with plate internal fixation in the treatment of Garden III and IV femoral neck fractures.Methods:Enrolled 24 patients with Garden III and IV femoral neck fractures admitted to our hospital from September 2018 to March 2020.The patients were divided into two groups using the random number table method.The observation group(n=12)used DAA approach to open reduction with 3 hollow screws combined with medial support plate internal fixation,and the control group(n=12)used closed reduction with 3 hollow screws internal fixation.The general information,intraoperative blood loss,operation time,hospitalization time,and postoperative Garden index reduction quality were compared between the two groups of patients.Both groups were followed up for 12 months to assess and record the fracture healing time and the Harris score of hip joint function.Complications such as femoral head necrosis,nonunion and failure of internal fixation.Through retrospective analysis to compare the clinical efficacy of the two surgical methods.Results:There was no statistically significant difference in general information between the observation group and the control group(p>0.05).All patients were followed up for 12 months.During the follow-up period,there was no nonunion of fracture or fracture of internal fixation.The average intraoperative blood loss of the observation group was(101.7±18.5)ml,the average operation time was(111.7± 11.7)minutes,the average intraoperative blood loss of the control group was(29.2± 14.4)ml,and the average operation time was(56.9±7.8))Minutes,the intraoperative blood loss and operation time of the observation group were higher than those of the control group,and the difference between the two groups was statistically significant(P<0.05).The average hospital stay in the observation group was(11.1± 1.6)days,and the average hospital stay in the control group was(9.6±2.0)days.There was no statistically significant difference between the two groups(P>0.05).The mean orthographic Garden index on X-rays of the observation group after operation was(161.0±3.90)degrees,the average lateral view was(176.3±4.3)degrees,and the average fracture healing time was(4.5±0.5)months.The average Garden index was(166.3±4.6)degrees,the average lateral view was(170.8±5.6)degrees,and the average fracture healing time was(5.3±0.6 months).The Garden reduction index of the observation group was more satisfactory than that of the control group,and the fracture healed The time was shorter than that of the control group,and the difference between the two groups was statistically significant(P<0.05).The Harris score of hip joint function in the observation group at 12 months after operation was 83-96 points,with an average of(90.8±3.8)points.Among them,8 cases were excellent(66.7%)and 4 cases(33.3%)were good.The Harris score of hip joint function in the last 12 months was 78 to 92 points,with an average of(86.9±4.7)points.Among them,6 cases were excellent(50%),4 cases were good(33.3%),and 2 cases were fair(16.7).%),the difference between the two groups was statistically significant(P<0.05).During the follow-up period of the observation group,no cases of femoral head necrosis and failure of internal fixation were found.In the control group,1 case(8.3%)of femoral head necrosis was found,and 3 cases(25.0%)had hollow screw retraction.A total of 4 cases(33.3%)had complications.The overall incidence of complications was not statistically significant between the two groups.(P>0.05)Conclusion:The DAA approach hollow screw combined with medial support plate internal fixation is used to treat Garden III and IV femoral neck fractures.Compared with the hollow screw internal fixation alone,there is more intraoperative blood loss and longer operation time,but it can improve fracture reduction Quality,shorten the healing time of fractures,and perform functional rehabilitation exercises as soon as possible for patients,which can improve hip joint function.Its curative effect is worthy of affirmation,and can provide reference for the clinical treatment of GardenⅢ and Ⅳ femoral neck fractures.