METHODS: We retrospectively reviewed all traumatic, nonpathologic Delbet II/III femoral neck fractures in patients below 18 years of age treated with PFLP or CS. All cases had ≥6 months of radiographic follow-up to evaluate for osseous union and AVN. Changes in proximal femoral alignment were determined by measuring injured and contralateral femoral neck-shaft angle and articulotrochanteric distance (ATD) between 6 and 12 months postoperatively.
RESULTS: Forty-two patients were identified with mean age at surgery of 10.7±2.9 years (range 3.3 to 16.3 years) and mean follow-up of 36±27 months. Sixteen patients (38%) underwent PFLP fixation, whereas 26 patients (62%) underwent CS fixation. When compared with the CS cohort, the PFLP cohort had a greater proportion of males (87.5% vs. 50%, P =0.02) and Delbet III fractures (68.8% vs. 15.4%, P <0.001). There was no difference between PFLP and CS cohorts with respect to rates of union (81% vs. 88%, respectively, P =0.66), AVN (25% vs. 35%, respectively, P =0.73), or secondary surgery (62% vs 62%, P =0.95). There was no significant difference in neck-shaft angle between injured and contralateral hips in those patients treated with PFLP ( P =0.93) or CS ( P =0.16). However, the ATD was significantly decreased in hips treated with CS compared with the contralateral hip (18.4±4.6 vs. 23.3±4.2 mm, P =0.001), with no significant difference in the PFLP group ( P =0.57).
CONCLUSIONS: This study suggests that the use of a PFLP in Delbet II/III femoral neck fractures does not appear to significantly increase nonunion rates or AVN and maintains anatomic ATD when compared with screw fixation.
METHODS: Level III-therapeutic study.
方法:我们回顾性回顾了所有创伤,使用PFLP或CS治疗的18岁以下患者的非病理性DelbetII/III型股骨颈骨折。所有病例均接受≥6个月的影像学随访,以评估骨性愈合和AVN。通过测量术后6至12个月的受伤和对侧股骨颈轴角度和关节转子距离(ATD)来确定股骨近端排列的变化。
结果:42例患者的平均年龄为10.7±2.9岁(范围为3.3至16.3岁),平均随访时间为36±27个月。16例(38%)患者行PFLP固定术,而26例(62%)患者接受CS固定术。与CS队列相比,PFLP队列的男性比例更高(87.5%vs.50%,P=0.02)和DelbetIII骨折(68.8%vs.15.4%,P<0.001)。PFLP和CS队列在结合率方面没有差异(81%与88%,分别,P=0.66),AVN(25%与35%,分别,P=0.73),或二次手术(62%对62%,P=0.95)。在接受PFLP(P=0.93)或CS(P=0.16)治疗的患者中,受伤臀部和对侧臀部之间的颈轴角度没有显着差异。然而,与对侧髋关节相比,接受CS治疗的髋关节的ATD显着降低(18.4±4.6vs.23.3±4.2mm,P=0.001),在PFLP组中无显著差别(P=0.57)。
结论:这项研究表明,与螺钉固定相比,在DelbetII/III型股骨颈骨折中使用PFLP似乎不会显着增加骨不连率或AVN,并维持解剖ATD。
方法:III级治疗性研究。