陈志龙 林大鹏 何文江 王海辉

【摘要】 目的：探究直接前入路（DAA入路）空心釘联合支撑钢板切开复位内固定在股骨颈骨折患者中的疗效及对骨愈合相关指标表达的影响。方法：选取2017年1月-2020年1月本院收治的85例股骨颈骨折患者为研究对象，将其随机分为对照组（外侧入路空心拉力螺钉内固定术组）42例和观察组（DAA入路空心钉联合支撑钢板切开复位内固定组）43例。比较两组术后Harris评分结果、手术前后骨愈合相关指标（BGP、ALP、OPG）及延迟愈合相关指标（sICAM-1、sVCAM-1）、并发症发生情况。结果：观察组术后6、12周Harris评分总优良率均显著高于对照组，差异均有统计学意义（P<0.05）。术前，两组骨愈合相关指标、延迟愈合相关指标比较，差异均无统计学意义（P>0.05）;术后4、8、12周，观察组骨愈合相关指标均显著高于对照组，延迟愈合相关指标均显著低于对照组，差异均有统计学意义（P<0.05）。观察组并发症发生率显著低于对照组，差异有统计学意义（P<0.05）。结论：DAA入路空心钉联合支撑钢板切开复位内固定在股骨颈骨折患者中的疗效较好，且对骨愈合相关指标表达的影响更好，因此在本类患者中的应用价值较高。

【关键词】 DAA入路空心钉联合支撑钢板切开复位内固定 股骨颈骨折 骨愈合相关指标

[Abstract] Objective： To investigate the effect of open reduction and internal fixation with cannulated screw and supporting plate by direct anterior approach （DAA approach） in the patients with femoral neck fracture and influence for the expression of bone healing related indexes. Method： A total of 85 patients with femoral neck fracture admitted to our hospital from January 2017 to January 2020 were selected as the research objects. The patients were randomly divided into control group （internal fixation with cannulated cancellors bone screws by lateral approach group group） and observation group （open reduction and internal fixation with cannulated screw and supporting plate by DAA approach group）. Postoperative Harris scores， bone healing related indexes （BGP， ALP and OPG） and delayed healing related indexes （sICAM-1 and sVCAM-1） before and after the operation， and complications of two groups were compared. Result： The total excellent and good Harris score rates of the observation group at 6 and 12 weeks after surgery were significantly higher than those of the control group， with statistically significant differences （P<0.05）. Before surgery， there were no statistically significant differences between two groups in bone healing related indicators and delayed healing related indicators （P>0.05）. At 4， 8， and 12 weeks after surgery， the bone healing related indexes in the observation group were significantly higher than those in the control group， and the delayed healing related indexes were significantly lower than those in the control group， with statistically significant differences （P<0.05）. The complication rate of the observation group was significantly lower than that of the control group， the difference was statistically significant （P<0.05）. Conclusion： The effect of open reduction and internal fixation with cannulated screw and supporting plate by DAA approach in the patients with femoral neck fracture is better， and its influence for the expression of bone healing related indexes are better， so its application value in these patients is higher.

[Key words] Open reduction and internal fixation with cannulated screw and supporting plate by DAA approach Femoral neck fracture Bone healing related indexes

First-authors address： Meizhou Hospital of Traditional Chinese Medicine （Tianjiabing Hospital of Meizhou）， Meizhou 514071， China

doi：10.3969/j.issn.1674-4985.2021.03.007

股骨颈骨折是临床常见骨折类型，因此与之相关的治疗研究也相对多见，而手术作为其主要治疗方式，不同的手术方式在临床效果与安全性方面存在较大差异[1-2]。另外骨愈合相关指标的表达情况也受治疗方式的影响较大，因此在治疗方式可取性的评估过程中，骨愈合相关指标的表达监测意义较高，且是临床疗效的重要评估方面[3-5]。本研究就DAA入路空心钉联合支撑钢板切开复位内固定在股骨颈骨折患者中的疗效及对骨愈合相关指标表达的影响进行探究，以了解本类手术方式对患者的影响程度，现报道如下。

1 资料与方法