| Background Femoral neck fracture(FNF)accounts for nearly half of hip fractures.With the development of transportation industry and construction industry,the proportion of Pauwels ? type of FNF caused by high energy injury also increased.Dynamic Hip Screw(DHS),as the representative of the sliding nail,is applied to FNF surgery,and its dynamic and static pressure function makes it play an important role in FNF treatment.The use of anti-rotation Screw enables it to overcome the disadvantages of simple DHS anti-rotation ability,so as to avoid the occurrence of coxa vara and other multiple related complications in the late stage.However,there is no uniform standard for how to screw the screw into fracture part until now.It is worth discussing that how to screw in the anti-rotation screw so as not to affect the dynamic and static pressure effect of the DHS,but also play a sufficient anti-rotation role.Objective To investigate the treatment effect of different angle between dynamic hip screw and the anti-rotation screw to cure Pauwels ? femoral neck fractures.Methods From October 2015 to August 2016,hip fracture patients were admitted in our hospital,and X-ray and 3D-CT reconstruction of the affected hip was taken to make a definite diagnosis of Pauwels ? type femoral neck fracture.The operation using DHS and anti-rotation screw were selected and performed.The patients are randomly divided into two groups,including the treatment group and the control group.In the treatment group,the anti-rotation screw was guided by the designed parallel guide.In the control group,the anti-rotation screw was set under the intra-operative X ray.Anteroposterior film was taken to measure the angle between the two screw(marked as a angle)and lateral film was taken to measure the angle between the two screw(marked as? angle)post-operatively.The time of operation,intra-operative blood loss,and postoperative quality evaluation of fracture reduction were collected and statistically analyzed.The patients were followed up at 3 months,6 months and 12 months post operation,and the fracture healing was observed.HHS score,WOMAC score were collected during each follow-up and VAS score was collected during the last time follow-up.Results There were 17 males and 13 females in the treatment group including 16 left and 14 right hips affected with mean age of 42.4± 12.1 years.There were 14 males and 16 females in the control group including 15 left and 15 right hips affected with mean age of 41.6±11.4 years.There were no significant differences between two groups in general information(P>0.05).The time interval of operation of the treatment group was 84.5±115.7 min which had significant differences to the control group of 101.3±30.5min(P<0.05).The intra-operative blood loss of the treatment group was 170.3±59.7ml which had significant differences to the control group of 170.3±59.7ml(P<0.05).The postoperative quality of fracture reduction of the treatment group,including 21 excellent,8 good,1 fair and zero poor,which had no significant difference to the control group including 16 excellent,11 good,3 fair and 0 poor(P>0.05).The a angle of the treatment group was 0.23±0.3°which had significant differences to the control group of 5.07± 0.6°(P<0.05).The ? angle of the treatment group was 0.24±0.3°which had no significant difference to the control group of 0.32±0.6'(P>0.05).2 cases were lost in the treatment group during the last time follow-up,and 4 cases were lost in the control group.The HHS scores during the 3-month,6-month and 12-month post-operative follow-up of the treatment group were 86.5±8.7,89.6±5.9,91.1 ±4.4 respectively which had significant differences to the control group of 82.5±10.8,83.6±10.0,84.5±9.9(P<0.05).The WOMAC scores during the 3-month,6-month and 12-month post-operative follow-up of the treatment group were 25.2±18.6,19.2±15.0,13.7± 10.9 respectively which had significant differences to the control group of 35.7±23.8,32.4±23.2,28.5±21.7(P<0.05).The VAS scores during the last time follow-up of the treatment group was 0.6±10.5 which had significant differences to the control group of 1.2±1.0(P<0.05).Conclusions The parallel dimension angle between the DHS nail and the anti-rotation screw nail can obtain better postoperative hip joint function and internal fixation comfort in the treatment of Pauwels ? femoral neck fracture of the short-term effect. |
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