【摘要】 目的探讨中青年股骨颈骨折空心螺钉内固定术后股骨头坏死的影响因素,为股骨颈骨折术后股骨头坏死预防提供理论依据。方法选取2013年2月至2015年2月于我院行空心螺钉内固定术治疗的145例中青年股骨颈骨折患者,2015年3月至2017年3月电话或复诊随访,共24个月,统计发生股骨头坏死病例。将股骨头坏死患者设为观察组,未发生者设为对照组,调查2组患者性别、年龄、骨折Garden分型、Garden指数等基本情况,通过单因素与多因素logistic回归分析确定股骨颈骨折空心螺钉内固定术后股骨头坏死的独立危险因素。结果 145例患者均完成随访,发生股骨头坏死20例,发生率13. 79%,股骨头坏死平均时间(15. 76±3. 54)个月; 2组受伤至手术时间、骨折Garden分型、Garden指数、术后开始负重时间、是否取出内固定、骨折移位、性别差异具有统计学意义(P <0. 05);手术时间、年龄、受伤原因差异无统计学意义(P> 0. 05);多因素logistic回归分析结果显示受伤至手术时间大于等于7 h[OR=1. 764,95%CI(0. 767~6. 565)]、骨折Garden分型Ⅲ、Ⅳ型[OR=2. 435,95%CI(1. 043~8. 665)]、负重时间小于3个月[OR=2. 043,95%CI(1. 022~5. 645)]、Garden指数Ⅲ、Ⅳ[OR=2. 231,95%CI(1. 116~5. 976)]、取出内固定[OR=1. 563,95%CI(0. 422~4. 643)]是中青年股骨颈骨折空心螺钉内固定术后股骨头坏死的独立危险因素。结论股骨颈骨折空心螺钉内固定术后股骨头坏死发生率较高,受伤至手术时间大于7 h、骨折Garden分型Ⅲ、Ⅳ型、术后开始负重时间小于3个月、Garden指数Ⅲ、Ⅳ以及取出内固定均会增加股骨头坏死风险。更多还原

【Abstract】 Objective To study the influencing factors of femoral head necrosis after hollow screw internal fixation surgery for young and middle-aged patient with femoral neck fracture and to provide theoretical basis for prevention of postoperative femoral head necrosis. Methods A total of 145 patients with femoral neck fractures treated with hollow screw internal fixation in our hospital from February 2013 to February2015 were selected as our objects. The patients were followed up by phone or follow-up from March 2015 to March 2017 for 24 months. Femoral head necrosis cases were counted. The patients with femoral head necrosis were set as the observation group and the others were set as the control group. The basic conditions such as sex,age,fracture Garden type and Garden index were investigated. The independent risk factors of femoral head necrosis after hollow screw internal fixation were determined by single-factor and multivariate factor logistic regression analysis.Results All of 145 patients were followed up,of whom 20 cases with femoral head necrosis,and the incidence rate was 13. 79%. The average time of femoral head necrosis was( 15. 76 ± 3. 54) months. There were significant differences in the time from injury to operation,Garden classification of fracture,Garden Index,the weight-bearing time after surgery,whether or not removal of internal fixation,fracture displacement and gender between the two groups( P < 0. 05). There was no significant difference in operative time,age and injury causes( P > 0. 05). Multivariate factor logistic regression analysis showed that the time from injury to operation was≥7 hours( OR = 1. 764,% 95 CI: 0. 767 ～ 6. 565),fractures Garden type Ⅲ and IV( OR = 2. 435,% 95 CI: 1. 043 ～ 8. 665),postoperative loading time < 3 months( OR = 2. 043,% 95 CI:1. 022 ～ 5. 645),Garden index Ⅲ and IV( OR = 2. 231,% 95 CI: 1. 116 ～ 5. 976) and removal of internal fixation( OR = 1. 563,% 95 CI :0. 422 ～ 4. 643) were the independent risk factors of femoral head necrosis after hollow screw internal fixation in young and middle-aged patients with femoral neck fractures. Conclusion The incidence of femoral head necrosis was high after hollow screw internal fixation for femoral neck fractures. The time from injury to operation > 7 hours,the fracture Garden type Ⅲ and IV,postoperative loading time< 3 months,Garden Index Ⅲ and IV and removal of Internal fixation can increase the risk of femoral head necrosis.更多还原