创伤性股骨颈骨折行闭合复位空心钉内固定后股骨头坏死情况及危险因素分析

Analysis of femoral head necrosis and risk factors after closed reduction and cannulated screw internal fixation for traumatic femoral neck fracture

目的:研究分析创伤性股骨颈骨折患者采用闭合复位空心钉内固定治疗后股骨头坏死的发生情况及相关危险因素。方法:研究纳入我院2014年10月~2017年12月收治的创伤性股骨颈骨折患者92例,所有患者均为新鲜骨折,入院后经影像学确诊并采用闭合复位空心钉内固定治疗,观察患者治疗后的情况并再经影像学确定股骨头坏死发生情况,依照有无股骨头坏死进行分组,分析两组患者相关临床资料,包括从男女构成/年龄/骨折分级/复位时间/固定物等指标进行危险因素的探讨,并采用Logistic线性回归分析股骨头坏死的主要危险因素。结果:全部92例患者经闭合复位空心钉内固定治疗后73例患者骨折处愈合或接近愈合,未见有其他并发症或严重不良反应发生,19例患者治疗后诊出股骨头坏死;依照是否发生股骨坏死分为发生组与未发生组,两组患者在性别及其他基线资料的比较中无统计学意义,结果显示两组患者在年龄/治疗时机、复位质量、骨折分型四个方向存在明显差异,检验结果均具有统计学意义;Logistic分析显示单因素显示股骨头坏死与年龄均呈负相关,与治疗时机、复位质量、骨折分型呈正相关关系,而综合因素分析得出骨折分型及复位质量对是否发生股骨头坏死的独立危险因素。结论:创伤性股骨颈骨折患者经闭合复位空心钉治疗后发生股骨头坏死的几率相对较高,而闭合复位的质量是影响患者预后的重要因素,骨折的类型、复位质量以及空心钉取出是导致患者术后发生股骨头坏死的重要危险因素,在临床治疗中应当这几项因素,并将其作为判断是否发生股骨头坏死的重要指标。

Objective To study the incidence and risk factors of femoral head necrosis after closed reduction and cannulated screw fixation in patients with traumatic femoral neck fracture.Methods 92 cases of traumatic femoral neck fracture were included in our hospital from October 2014 to December 2017.All of them were fresh fractures.After admission,they were diagnosed by radiology and treated by closed reduction and cannulated nail internal fixation.The femoral head necrosis was divided into two groups,and the clinical data of the two groups were analyzed,including the risk factors of femoral head necrosis by sex composition/age/fracture classification/reduction time/fixture and so on.The main risk factors of femoral head necrosis were analyzed by logistic linear regression.Results All 92 patients were treated with closed reduction and cannulated screw fixation.73 patients healed or nearly healed.No other complications or serious adverse reactions were found.19 patients were diagnosed as femoral head necrosis after treatment.There was no significant difference in baseline data between the two groups.The results showed that there were significant differences in age/treatment time,reduction quality and fracture classification between the two groups,and the results were statistically significant.There was a positive correlation between the quality of reduction and the type of fracture.The comprehensive factor analysis showed that the type of fracture and the quality of reduction had the greatest influence on the occurrence of femoral head necrosis.Conclusion The incidence of femoral head necrosis in patients with traumatic femoral neck fracture after closed reduction and cannulated screw treatment is relatively high,and the quality of closed reduction is an important factor affecting the prognosis of patients.Fracture type,reduction quality and cannulated screw removal are important risk factors for femoral head necrosis after operation.In clinical treatment,these factors should be taken as an important index to judge whether femoral head necrosis occurs.