Objective: To investigate the clinical efficacy of dynamic cross screw system (FNS) for femoral neck fractures in young and middle-aged patients with posterior medial comminution. Methods: A retrospective cohort study. Clinical data of 197 young and middle-aged patients with femoral neck fractures accompanied by posterior medial comminution treated with closed reduction FNS and internal fixation with anti-rotation cannulated screws in Beijing Luhe Hospital, Beijing Jishuitan Hospital and Beijing Tongren Hospital from October 2019 to October 2021 were analyzed retrospectively. According to different surgical methods, the patients were divided into two groups. There were 102 patients in the FNS group, included 55 males and 47 females with a mean age of (40.49±19.79) years; and there were 95 patients in the FNS plus anti-rotation hollow screw group (combined group), included 51 males and 44 females with an average age of (40.03±18.82) years. All patients were followed-up for at least 1 year after surgery. The general clinical data, surgical conditions and Harris score of the hip joint at the last follow-up of the two groups were compared. And the clinical efficacy of the two surgical schemes were evaluated and compared. After surgery, routine X-ray and CT examinations were performed to evaluate the fracture reduction and internal fixation, and the shortening of the femoral neck on the affected side was compared to that of healthy side according to the Zlowodzki method. Results: At the last follow-up, the incidence of fracture reduction loss, screw resection and coxa vara in the combined group were all significantly lower than those in the FNS group [10 (10.5%) vs 28 (27.4%), 1 (1.0%) vs 7 (6.8%) and 9 (9.4%) vs 21 (20.5%), respectively, all P<0.05]. The incidence of nonunion and necrosis of the femoral head in the combined group were both lower than those in the FNS group, but there was no significant difference between two groups (both P>0.05). The postoperative mild, moderate and severe femoral neck shortening in the combined group were all lower than those in the FNS group, and the difference were not statistically significant (all P>0.05). At the last follow-up, the Harris score in the combined group was 84.60±2.08, and it was higher than that in the FNS group (79.57±4.31), but the difference was not statistically significant (P=0.403). Conclusion: FNS plus supporting hollow screw has a good clinical effect on femoral neck fractures in young and middle-aged adults with posterior medial comminution.
目的： 探讨股骨颈动力交叉钉系统（FNS）联合支撑空心螺钉对伴后内侧粉碎的中青年股骨颈骨折患者的临床疗效。 方法： 回顾性队列研究。回顾性分析2019年10月至2021年10月首都医科大学附属北京潞河医院、北京积水潭医院和北京同仁医院应用闭合复位FNS和FNS加防旋空心螺钉内固定治疗的197例伴后内侧粉碎的中青年股骨颈骨折患者临床资料。根据不同手术方式分为2组，其中FNS组102例，男55例，女47例，年龄（40.49±19.79）岁；FNS加防旋空心螺钉组（联合组）95例，男51例，女44例，年龄（40.03±18.82）岁。所有患者术后至少随访1年。观察和比较2组患者一般临床资料、手术情况及末次随访时髋关节Harris评分，评估比较两种手术方案的临床疗效。术后常规行X线片、CT检查评估骨折复位及内固定情况，并根据Zlowodzki方法测量患侧较健侧股骨颈短缩情况。 结果： 末次随访时，联合组骨折复位丢失、螺钉切除和髋内翻发生率均低于FNS组，差异均有统计学意义［分别为10（10.5%）比28（27.4%）、1（1.0%）比7（6.8%）和9（9.4%）比21（20.5%），均P<0.05］。联合组骨折不愈合和股骨头坏死发生率亦均低于FNS组，但差异均无统计学意义（均P>0.05）。联合组患者的术后股骨颈轻度、中度及重度短缩均少于FNS组，差异亦均无统计学意义（均P>0.05）。末次随访时，联合组的Harris评分为（84.60±2.08）分，高于FNS组的（79.57±4.31）分，但差异无统计学意义（P=0.403）。 结论： 对于伴后内侧粉碎的中青年股骨颈骨折，FNS联合支撑空心螺钉具有良好的临床疗效。.