| Objective:We conducted a retrospective study to identify the risk factors for avascular necrosis of the femoral head and fixation failure after internal fixation in patients with femoral neck fractures,to evaluate the life quality of patients with femoral head surial and quantify its predictors;We summarized the characteristics of different TCM syndromes and demonstrated that TCM treatment can improve patients'recoveries after surgeries.We successfully built a finite element analysis model of Pauwels type III femoral neck fractures with posterior comminution,and try to find out the biomechanical characteristics of three configurations of cannulated compression screws for this kind-of fracture.Meanwhile,We conducted a prospective study to observe the clinical efEicacy of Gumibao decoction in the treatment of femoral neck fracture.Methods:(1)172 patients(174 hips)after closed reduction and internal fixation with cannulated compression screws were involved from January 2013 to December 2016 in Suzhou Hospital of TCM in the retrospective study,With a mean follow-up of 43.5 months.The patients1 general information including age,sex,body mass index(BMI),mechanism of injury,injury-to-surgery interval,implant removal,and patients' radiographic information including Garden Type,Pauwel's classification,posterior tilt,reduction quality,screws distribution were evaluated by the univariate analysis and multivariate logistic regression analyses.The patients without femoral head necrosis after internal fixation were followed up.Their quality of life was assessed by SF-36,and the joint function was assessed by Hip Harris Score.We use multiple linear regression analysis to predict the quality of life of the patients.TCM syndrome information was collected for classification,and the number of each syndrome type was recorded.(2)We established the finite element model of Pauwel's type ? femoral neck fracture with posterior comminution,used professional finite element software to simulate cutting 700°fracture line and 1.5×1.0X0.5mm bone blocks in the posterior wall after cutting,obtained data from CT images in DICOM format of right proximal femur of healthy volunteers.In the software Ansys13.0,the stress distribution and highest peak stress,deformation distribution and highest peak deformation of the model under the condition of standing on one leg were measured.The biomechanical stability of screw fixation with different configurations was analyzed.(3)During the period from January 2017 to December 2018,48 patients were involved in the prospective study.They all had been treated with closed reduction and internal fixation with cannulated compression screws because of their femoral neck fractures,and be classified as the renal deficiency and blood stasis type of TCM symptom.They were evenly divided into two groups,the observation group and the control group.The 24 patients in the control group were treated with surgery alone,and the other 24 patients in the observation group were treated with the Gumibao decoction after surgery.Their fracture healing time,hip harris score and SF-36 after 6 and 12 months,femoral neck shortening after 1 year and walking ability at the last follow-up were all recorded.The study was aimed to evaluate the clinical efficiency of the Gumibao decoctin.Results:(1)There were AVN in 29 patients(16.67%),while fixation failure(FF)in 36 patients(20.69%).A poor quality of reduction and posterior tilt>15 were associated with a higher risk of AVN and FF in the multivariate logistic regression analysis.The harris hip scores of femoral head surial patients at the final follow-up was 90.14±7.92.They were excellent in 96 hips(70.07)%,good in 28 hips(20.44%)and poor in 13 hips(9.49%).The PCS score was 46.12±9.12,and MCS score was 50.21±3.97.There was a nonlinear relation between them(P>0.05).In the multivariate logistic regression analysis,a poor quality of reduction and posterior tilt>15 were associated with a bad PCS score,and the trauma mechanism and displace fracture were associated with a bad MCS score.There were 67 cases of kidney deficiency syndrome,42 cases of blood stasis syndrome and 29 cases of spleen deficiency syndrome,among which the proportion of kidney deficiency syndrome was the highest(P<0.001).In the complex syndrome type,there were 16 cases of kidney deficiency and blood stasis syndrome,5 cases of spleen deficiency and blood stasis syndrome,3 cases of spleen and kidney deficiency and blood stasis syndrome,and 4 cases of spleen deficiency and kidney deficiency,among which the proportion of kidney deficiency and blood stasis syndrome was the highest(P<0.05).The PCS scores of patients with kidney deficiency syndrome,blood stasis syndrome,kidney deficiency and blood stasis syndrome and three syndromes were lower than those without the above syndromes(P<0.05),and the PCS scores of patients with blood stasis syndrome were the lowest(P<0.001).(2)Stress of cannulated compression screws was intensely focused on the middle area of the screw near the fracture line of each group.The positive triangle model showed the highest peak stress was 171.45MP.The positive triangle model showed the highest peak stress was 171.45MP.The inverted triangle model showed the high est peak stress was 146.19MP.And the BDSF model showed the highest peak stress was 135.19Mpa.(3)The healing time was 6.72±3.18 months in the control group and was 5±2.39 months in the observation group which had a certain advantage(P<0.05).There were no significant differences between the observation and control group about the HHS,PCS and MCS after 6 months.There were a higher HHS and a higher PCS in the observation group after 12 months(P<0.05).But there was no significant difference about the MCS between the 2 groups(P>0.05).The walking ability and the femoral neck shortening didn't show a significant difference between the groups at the final follow-up(P>0.05).Conclusion:(1)A poor quality of reduction and posterior tilt>15 were all risk factors for AVN.Hip function and MCS recovery of patients were good,but the PCS could not return to the average level of normal population.A poor quality of reduction and posterior tilt>15 were associated with a poor PCS.The trauma mechanism and displace fracture were associated with a bad MCS.The patients with kidney deficiency syndrome or blood stasis syndrome may have a worse outcome of their physiological function.(2)The positive triangle model,the inverted triangle model and the BDSF model all could be used to the treatment of Pauwels type ? femoral neck fractures with posterior comminution.But the BDSF model showed a better mechanical advantage.(3)The femoral neck fracture patients could benefit from the Gumibao decoction treatment.It can help the patients by promoting healing of the fracture,improving the joint function and physiological function. |
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