| Objective:(1)Useing adult healthy sheep in Lanzhou area as experimental subjects to model femoral neck fractures in young adults,compare the effects of different nailing methods on imaging changes,biomechanical stability,and histopathological changes in femoral neck fractures of sheep.to obtain the best setting of nails,provide experimental basis for clinical treatment of femoral neck fractures in young adults;(2)Through clinical comparison observation,discussed the clinical efficacy of hollow compression screw internal fixation combined with Sunshang Capsule in the treatment of femoral neck fractures in young and middle-aged Chinese.Methods:1.Experimental study: Twelve native sheep were selected and randoml y divided into three groups of A,B,and C,3 in each group,and 3 in reserve.Group A was an equilateral triangle fixation group,and Group B was an inverted triangle fixatio n group,The group C was a blank model group.The right femoral neck fracture was c aused by the surgical method under direct vision.Group A was fixed with an equilater al triangle,Group B was fixed with an inverted triangle,and Group C was not fixed.On e month,two months and three months after surgery,one group was randomly selected for Videography?biomechanical examination and Histopathological examination.Statistica l analysis.2.Clinical observation:In strict accordance with inclusion criteria and exclusion criteria,Select 52 patients with femoral neck fractures treated in joint surgery of Affiliated Hospital of Gansu University of Traditional Chinese Medicine between January 2016 and December 2017.According to the principle of randomization,patients were divided into simple surgery group and surgery combined Sunshang capsule group.Both groups underwent conventional preoperative examination and were treated with hollow compression screw fixation.The two groups were given routine symptomatic supportive care after surgery,the surgical combined Sunshang capsule group was administered on the basis of routine treatment to the oral preparation of “Sunshang capsule” of the Affiliated Hospital of Gansu University of Traditional Chinese Medicine.Three days after the surger,two times a day,once three times,orally for 3 months.Through clinical follow-up observation of patients after X-rayexamination results to understand fracture healing and femoral head necrosis.At the last follow-up,Harris hip function score was used to evaluate the curative effect.The rate of good treatment between the two groups was compared.Result:1.Experimental study: During the experiment,one sheep in group A died on the second day after surgery.One of the three spare sheep was modeled as a straight delta placement and was included in group A to continue observation.All of the final group experimental sheeps were survived.(1)Radiographic findings:In the first month after surgery,the fracture lines of all groups began to become blurred.The gradual formation of osteophytes was seen at the femoral neck fractures.The femoral head was well-shaped and normal in density.There was no obvious cystic degeneration.There was no obvious femoral head area;After 2 months,the fracture lines of all groups had basically disappeared.In group A,the bones of the femur were hardly stiffened.The shape,density,and size of the femoral head were normal in the group B.The skull of the femure in the group C was partially hardened,and the cystic changes of the femoral head were mild.After 3 months,the fracture lines of all groups disappeared completely,tending to heal clinically.In Group A,obvious bone sclerosis appeared,and the femoral head shape change.In Group B,the femoral head had a normal shape without collapse,and the bone density in the femoral head was normal.Decreased density of the femoral head revealed significant cystic changes.(2)Biomechanical examination results:Comparing the load displacements at different loading pressures after one month,two months,and three months after surgery:Group B was better than Group A,and Group A was better than Group C.The difference was statistically significant(P<0.05).after one month,two months,nd three months.in the vertical compression test,the results of the elastic modulus and yield strength of each group were:Group B was better than Group A,Group A was better than Group C,and each group was vertical.Statistically significant differences in compressive mechanical properties were obtained(P<0.05).(3)Histopathological examination results:After one month,two months,and three months after operation,the number of bone cells,the arrangement of bone trabecula,and the presence or absence of empty lacunae in each group were observed,Group B was superior to group A,and group A was superior to group C.There was a statistically significant difference in thepercentage of counts of empty bone lacunae in each group(P<0.05).2.Clinical observation: 51 patients were clinically followed up for 8 to 24 months with an average of 13 months.In the simple surgery group,6 cases of nonunion fractures and 9cases of femoral head necrosis were found.The non-healing rate is 21.43%.The femoral head necrosis rate was 32.14%;In the surgery combined Sunshang capsule group,there was 4 case of nonunion of fracture and 6 cases of femoral head necrosis.The rate of fracture nonunion was 17.39% and the rate of femoral head necrosis was 26.09%,There was no statistically significant difference in the rate of nonunion and femoral head necrosis in each group(P>0.05).At the last follow-up hip hip score,the simple surgery group: pain score(37.71±6.43)points,functional score(36.11±10.47)points,malformation scores(3.29±1.56)points,exercise range scores(3.43±0.69)points,total scores(80.54±17.07)points;Results: Excellent in 10 cases,good in 9 cases,moderate in 4 cases,poor In 5 cases,the excellent rate was67.86%.the surgery combined Sunshang capsule group had a pain score of(41.30±5.64),a functional score of(42.43±5.96),a malformation score of(4.00±0.00),and a sports range score of(3.29±1.56).The total score was(91.57±11.39)points;among the results: excellent in15 cases,good in 5 cases,fair in 1 case,poor in 2 cases,excellent rate of 86.96%;For each value comparison,there was a statistically significant difference in pain score,functional score,malformation score,exercise range score,total score,and excellent rate(P<0.05).Conclusion:1.Three hollow compression screws were used to treat femoral neck fractures of young and middle-aged patients with inverted triangular placement.Compared with normal triangle placement in fracture healing,biomechanical stability and histological changes,they can be used as a basis experiments for clinical use.2.Three hollow compression screw fixations for the treatment of femoral neck fractures in young adults have a high cure rate and reliable clinical efficacy.It is worth promoting.3.Hollow compression screw internal fixation combined Sunshang capsule can signi ficantly reduce patient pain,improve hip function activities,to avoid deformities,etc.im prove the patient's quality of life,improve the fine rate of femoral neck fractures in yo ung and middle-aged,The combination of Chinese medicine treatment of young and middle-aged femoral neck fractures is more superior than simple surgical treatment and i s worthy of clinical application. |
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