【摘要】 目的分析股骨颈骨折空心钉内固定后发生股骨头缺血坏死的相关因素及防治方法。方法总结行空心钉治疗的212例新鲜股骨颈骨折的资料。病人年龄13~70岁,平均45.2岁。骨折的Garden分型:Ⅰ型3例,Ⅱ型32例,Ⅲ型107例,Ⅳ型53例。随访期限12~101个月,平均32.7个月。结果9例发生骨折不愈合,骨折愈合率95.8%。发生股骨头缺血坏死70例(33.0%),发展成股骨头晚期塌陷30例(14.3%)。股骨头缺血坏死的发现时间大多数在伤后3年内(95.7%)。股骨头缺血坏死和晚期塌陷的主要相关因素是骨折Garden分型(P=0.0002)。年龄>60岁、受伤至手术间隔<14 d、复位后正侧位Garden指数均在155~180度者有较低的股骨头缺血坏死和晚期塌陷率。结论骨折Garden分型是影响股骨头缺血坏死和晚期塌陷的发生的最主要因素,急诊手术及良好的骨折复位有助于减少股骨头缺血坏死的发生。更多还原

【Abstract】 Objective To observe the accidence of avascular necrosis of the femoral head after internal fixation with cannulated screws in femoral neck fractures and analysis of the related factors.Methods 212 cases of femoral neck fracture treated with cannulated screws between Sep.1989 and Dec.1999 were reviewed retrospectively.The average age was 45.2 years old,ranging from 13 to 70 years.Among the fractures,3 were Garden stage Ⅰ,32 were Garden stage Ⅱ,107 were Garden stage Ⅲ,53 were Garden stage Ⅳ,and 17 unclassified.Average duration of follow-up was 32.7 months,ranging from 12 to 101 months.Results Fracture healing occurred in 203 cases(95.8%). Avascular necrosis of the femoral head occurred in 70 cases(33.0%) and late collapse developed in 30 cases(14.3%).The rate of the avascular necrosis and late collapse of the femoral head according to the Garden stage was 0/0,Garden stage Ⅰ;6.3%/0,Garden stage Ⅱ;33.6%/15.9%,Garden stage Ⅲ;49.1%/20.8%,Garden stage Ⅳ.Avascular necroses of the femoral head were observed within 3 years in most cases(95.7%).Correlation analysis shows Garden stage of the fracture was the major factor contributed to the accidence of avascular necrosis and late collapse of the femoral head.It also shows the low risk of avascular necrosis and late collapse of the femoral head was related to the patient′s age over 60;time of surgery within 14 days and Garden′s reduction index within 155-180° on both AP and Lateral views.Conclusion Garden stage of the fracture is the major factor contributed to the accidence of avascular necrosis and late collapse of the femoral head,emergency operation and good reduction is beneficial to reduce the accidence of avascular necrosis of femoral head.更多还原