Study on effectiveness of treating femoral neck fractures based on theory of “positive support”_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Liu , MO Gang , XU Lin , LI Yang ,  RUAN Shiqiang

Department of Orthopedics, the First People’s Hospital of Zunyi, the Third Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P. R. China;

Corresponding?author：

RUAN Shiqiang, Email: 770694368@qq.com

Keywords：

Femoral neck fracture; positive support; fracture reduction; internal fixation

DOI：

10.7507/1002-1892.202304081

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To explore effectiveness of positive support reduction and internal fixation in the treatment of femoral neck fractures. Methods A clinical data of 74 patients with femoral neck fractures treated with hollow screw internal fixation between September 2017 and September 2021 was retrospectively analyzed. Based on the quality of fracture reduction, they were divided into positive support reduction group (group A, n=25), negative support reduction group (group B, n=21), and anatomical reduction group (group C, n=28). There was no significant difference in baseline data such as gender, age, cause of injury, disease duration, fracture side, Garden classification, and fracture line position classification between groups (P>0.05). The occurrence of complications such as early fixation failure, femoral neck shortening, non-union of fractures, and femoral head necrosis in three groups, as well as the Harris score of the hip joint were recorded and compared. Results All patients had primary healing of incisions after operation and were followed up more than 12 months. The follow-up time for groups A, B, and C was (21.1±5.7), (22.6±4.3), and (21.9±4.1) months, respectively; there was no significant difference between groups (P>0.05). There was no significant difference in the incidences of non-union of fractures, early internal fixation failure, and the femoral head necrosis between groups (P>0.05). The incidence and length of femoral neck shortening, and the hip Harris score at last follow-up in groups A and C were all superior to those in the group B, with significant difference (P<0.05). There was no significant difference in the above indicators between groups A and C (P>0.05). Conclusion Positive support reduction can provide a good biomechanical environment for the healing of femoral neck fractures, thereby achieving a higher fracture healing rate, reducing the occurrence of femoral neck shortening, minimizing the function of hip joint, and achieving effectiveness similar to anatomical reduction.

Citation： YANG Liu, MO Gang, XU Lin, LI Yang, RUAN Shiqiang. Study on effectiveness of treating femoral neck fractures based on theory of “positive support”. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(8): 958-963. doi: 10.7507/1002-1892.202304081 Copy

1.	汪天豪, 李榮群, 周軍, 等. 經皮加壓鋼板治療中青年股骨頸骨折療效分析. 中國修復重建外科雜志, 2022, 36(6): 708-713.
2.	Slobogean GP, Sprague SA, Scott T, et al. Complications following young femoral neck fractures. Injury, 2015, 46(3): 484-491.
3.	Sugand K, Ali R, Goodall R, et al. Trends in neck of femur fracture incidence in EU15+ Countries from 1990-2017. Injury, 2023, 54(2): 645-651.
4.	周述清, 朱秋汶, 申洪全, 等. 股骨頸骨折內固定治療的生物力學研究進展. 創傷外科雜志, 2020, 22(5): 391-394.
5.	齊書環, 趙繼朋. 股骨頸骨折復位內固定術后股骨頭壞死的危險因素分析. 中國燒傷創瘍雜志, 2022, 34(4): 258-261.
6.	冀家琛, 王敏, 董亮, 等. 股骨頸系統與空心釘固定青壯年股骨頸骨折. 中國矯形外科雜志, 2022, 30(22): 2022-2027.
7.	Wang Y, Ma JX, Yin T, et al. Correlation between reduction quality of femoral neck fracture and femoral head necrosis based on biomechanics. Orthop Surg, 2019, 11(2): 318-324.
8.	Gotfried Y, Kovalenko S, Fuchs D. Nonanatomical reduction of displaced subcapital femoral fractures (Gotfried reduction). J Orthop Trauma, 2013, 27(11): e254-e259.
9.	田力升. 解剖復位、Gotfried支撐復位用于青年股骨頸骨折的遠期隨訪觀察. 中國現代醫藥雜志, 2018, 20(1): 26-29.
10.	陳彥平, 王芳芳, 王金良, 等. Gotfried支撐復位治療股骨頸骨折中青年患者的臨床研究. 臨床和實驗醫學雜志, 2022, 21(5): 518-522.
11.	徐林, 阮世強, 柏小金. 內固定治療股骨頸骨折失敗原因分析. 重慶醫學, 2011, 40(12): 1223-1224.
12.	王剛. 基于Pauwels分型相關的股骨頸骨折陽性支撐復位定量研究與一種新型鋼板的研制. 蘇州: 蘇州大學, 2020.
13.	李偉龍, 余霄, 龐清江. 股骨頸骨折內固定術后股骨頸短縮的相關研究進展. 中華骨科雜志, 2016, 36(6): 378-384.
14.	張長青, 張偉. 股骨頸骨折內固定治療的挑戰與應對. 中華創傷骨科雜志, 2021, 23(6): 467-469.
15.	Liu C, Liu MT, Li P, et al. Efficacy evaluation for the treatment of subcapital femoral neck fracture in young adults by capsulotomy reduction and closed reduction. Chin Med J (Engl), 2015, 128(4): 483-488.
16.	Huang K, Fang X, Li G, et al. Assessing the effect of Gotfried reduction with positive buttress pattern in the young femoral neck fracture. J Orthop Surg Res, 2020, 15(1): 511.
17.	Wang G, Wang B, Wu X, et al. Gotfried positive reduction promotes the repair of femoral neck fracture potentially via enhancing osteogenesis and angiogenesis. Biomed Pharmacother, 2020, 123: 109801.
18.	丁舒晨, 虞榮斌, 葛云林, 等. Gotfried陽性支撐復位結合空心螺釘內固定治療中青年股骨頸骨折的近期療效. 中華創傷骨科雜志, 2016, 18(8): 655-661.
19.	劉祥, 方紅育, 黃濤, 等. 股骨頸骨折空心螺釘治療失敗因素的Meta分析. 中華關節外科雜志 (電子版), 2018, 12(4): 523-533.
20.	李林濤, 何榮富, 王應兵. Gtfried陽性支撐復位結合經皮加壓鋼板治療中青年股骨頸骨折髖關節功能、生物力學及并發癥分析. 黑龍江醫學, 2022, 46(6): 648-651.
21.	宛磊, 代彭威, 王偉, 等. 股骨頸骨折空心螺釘內固定術后股骨頸短縮發生率及對患者預后的影響. 罕少疾病雜志, 2017, 24(4): 58-60.
22.	楊家趙, 周雪鋒, 李黎, 等. 股骨頸動力交叉釘系統和倒三角空心釘治療PauwelsⅢ型股骨頸骨折療效比較. 中國修復重建外科雜志, 2021, 35(9): 1111-1118.
23.	馮曉飛, 余霄, 龐清江. 股骨頸骨折內固定術后股骨頸短縮的臨床特點. 中華骨與關節外科雜志, 2018, 11(5): 364-369.
24.	季仁晨, 盧星華, 叢日成, 等. 全螺紋空心加壓螺釘與部分螺紋空心螺釘治療股骨頸骨折的療效比較研究. 中國修復重建外科雜志, 2023, 37(1): 19-24.
25.	陳澤銘, 楊放, 余盛, 等. 預防股骨頸骨折空心釘內固定術后股骨頸短縮空心螺紋釘優化選擇的有限元分析. 中國骨傷, 2022, 35(11): 1042-1048.
26.	Felton J, Slobogean GP, Jackson SS, et al. Femoral neck shortening after hip fracture fixation is associated with inferior hip function: results from the FAITH trial. J Orthop Trauma, 2019, 33(10): 487-496.
27.	Zlowodzki M, Brink O, Switzer J, et al. The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study. J Bone Joint Surg (Br), 2008, 90(11): 1487-1494.
28.	王琦, 高波, 張禹. Gotfried陽性支撐復位聯合內固定治療股骨頸骨折一年隨訪觀察. 中國實用醫刊, 2017, 44(21): 35-38.

1. 汪天豪, 李榮群, 周軍, 等. 經皮加壓鋼板治療中青年股骨頸骨折療效分析. 中國修復重建外科雜志, 2022, 36(6): 708-713.
2. Slobogean GP, Sprague SA, Scott T, et al. Complications following young femoral neck fractures. Injury, 2015, 46(3): 484-491.
3. Sugand K, Ali R, Goodall R, et al. Trends in neck of femur fracture incidence in EU15+ Countries from 1990-2017. Injury, 2023, 54(2): 645-651.
4. 周述清, 朱秋汶, 申洪全, 等. 股骨頸骨折內固定治療的生物力學研究進展. 創傷外科雜志, 2020, 22(5): 391-394.
5. 齊書環, 趙繼朋. 股骨頸骨折復位內固定術后股骨頭壞死的危險因素分析. 中國燒傷創瘍雜志, 2022, 34(4): 258-261.
6. 冀家琛, 王敏, 董亮, 等. 股骨頸系統與空心釘固定青壯年股骨頸骨折. 中國矯形外科雜志, 2022, 30(22): 2022-2027.
7. Wang Y, Ma JX, Yin T, et al. Correlation between reduction quality of femoral neck fracture and femoral head necrosis based on biomechanics. Orthop Surg, 2019, 11(2): 318-324.
8. Gotfried Y, Kovalenko S, Fuchs D. Nonanatomical reduction of displaced subcapital femoral fractures (Gotfried reduction). J Orthop Trauma, 2013, 27(11): e254-e259.
9. 田力升. 解剖復位、Gotfried支撐復位用于青年股骨頸骨折的遠期隨訪觀察. 中國現代醫藥雜志, 2018, 20(1): 26-29.
10. 陳彥平, 王芳芳, 王金良, 等. Gotfried支撐復位治療股骨頸骨折中青年患者的臨床研究. 臨床和實驗醫學雜志, 2022, 21(5): 518-522.
11. 徐林, 阮世強, 柏小金. 內固定治療股骨頸骨折失敗原因分析. 重慶醫學, 2011, 40(12): 1223-1224.
12. 王剛. 基于Pauwels分型相關的股骨頸骨折陽性支撐復位定量研究與一種新型鋼板的研制. 蘇州: 蘇州大學, 2020.
13. 李偉龍, 余霄, 龐清江. 股骨頸骨折內固定術后股骨頸短縮的相關研究進展. 中華骨科雜志, 2016, 36(6): 378-384.
14. 張長青, 張偉. 股骨頸骨折內固定治療的挑戰與應對. 中華創傷骨科雜志, 2021, 23(6): 467-469.
15. Liu C, Liu MT, Li P, et al. Efficacy evaluation for the treatment of subcapital femoral neck fracture in young adults by capsulotomy reduction and closed reduction. Chin Med J (Engl), 2015, 128(4): 483-488.
16. Huang K, Fang X, Li G, et al. Assessing the effect of Gotfried reduction with positive buttress pattern in the young femoral neck fracture. J Orthop Surg Res, 2020, 15(1): 511.
17. Wang G, Wang B, Wu X, et al. Gotfried positive reduction promotes the repair of femoral neck fracture potentially via enhancing osteogenesis and angiogenesis. Biomed Pharmacother, 2020, 123: 109801.
18. 丁舒晨, 虞榮斌, 葛云林, 等. Gotfried陽性支撐復位結合空心螺釘內固定治療中青年股骨頸骨折的近期療效. 中華創傷骨科雜志, 2016, 18(8): 655-661.
19. 劉祥, 方紅育, 黃濤, 等. 股骨頸骨折空心螺釘治療失敗因素的Meta分析. 中華關節外科雜志 (電子版), 2018, 12(4): 523-533.
20. 李林濤, 何榮富, 王應兵. Gtfried陽性支撐復位結合經皮加壓鋼板治療中青年股骨頸骨折髖關節功能、生物力學及并發癥分析. 黑龍江醫學, 2022, 46(6): 648-651.
21. 宛磊, 代彭威, 王偉, 等. 股骨頸骨折空心螺釘內固定術后股骨頸短縮發生率及對患者預后的影響. 罕少疾病雜志, 2017, 24(4): 58-60.
22. 楊家趙, 周雪鋒, 李黎, 等. 股骨頸動力交叉釘系統和倒三角空心釘治療PauwelsⅢ型股骨頸骨折療效比較. 中國修復重建外科雜志, 2021, 35(9): 1111-1118.
23. 馮曉飛, 余霄, 龐清江. 股骨頸骨折內固定術后股骨頸短縮的臨床特點. 中華骨與關節外科雜志, 2018, 11(5): 364-369.
24. 季仁晨, 盧星華, 叢日成, 等. 全螺紋空心加壓螺釘與部分螺紋空心螺釘治療股骨頸骨折的療效比較研究. 中國修復重建外科雜志, 2023, 37(1): 19-24.
25. 陳澤銘, 楊放, 余盛, 等. 預防股骨頸骨折空心釘內固定術后股骨頸短縮空心螺紋釘優化選擇的有限元分析. 中國骨傷, 2022, 35(11): 1042-1048.
26. Felton J, Slobogean GP, Jackson SS, et al. Femoral neck shortening after hip fracture fixation is associated with inferior hip function: results from the FAITH trial. J Orthop Trauma, 2019, 33(10): 487-496.
27. Zlowodzki M, Brink O, Switzer J, et al. The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study. J Bone Joint Surg (Br), 2008, 90(11): 1487-1494.
28. 王琦, 高波, 張禹. Gotfried陽性支撐復位聯合內固定治療股骨頸骨折一年隨訪觀察. 中國實用醫刊, 2017, 44(21): 35-38.

Chinese Journal of Reparative and Reconstructive Surgery

Study on effectiveness of treating femoral neck fractures based on theory of “positive support”

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