成人股骨颈骨折术式量化评分表的制定及其初步临床应用

Design and clinical application of a quantitative scale for adult femoral neck fractures

目的设计股骨颈骨折术式量化评分表，并按此表对股骨颈骨折手术患者进行回顾性分析，评价其与临床实践的一致性及指导意义。方法根据股骨颈骨折术式量化评分表，对2007年1月至2010年4月期间因股骨颈骨折行手术治疗的700例患者资料进行回顾性分析，其中符合评分表纳入标准且资料完整者502例。按评分高低和实际治疗方法将其分为4组：低分内固定组（281例）、全髋关节置换组（94例）、半髋关节置换组（119例）和高分内固定组（8例），每组内以是否按照评分表治疗进一步分成一致组与不一致组。比较组间的手术时间、出血量、输血量、感染率、再手术或翻修率、死亡率及髋关节Harris评分等。结果502例患者术后获平均3．2年（1．0～4．5年）随访，一致性检验Kappa系数为0．549（P=0．000），说明评分表与临床治疗具有一致性。低分内固定组：一致组的骨折不愈合率（1．2％）、股骨头坏死率（7．4％）和再手术率（7．0％）低于不一致组（17．9％、33．3％、41．0％），Harris评分[（86．4±9．9）分]高于不一致组[（74．8±10．8）分]，以上项目两组间比较差异均有统计学意义（P〈0．05）。全髋关节置换组：一致组的翻修率（1．6％）低于不一致组（18．2％），Harris评分[（92．0±6．3）分]高于不一致组[（85．9±11．6）分]，以上项目两组间比较差异均有统计学意义（P〈0．05）。半髋关节置换组：一致组的翻修率（5．5％）低于不一致组（18．8％），差异有统计学意义（Х^2=4．746，P=0．029）。结论成人股骨颈骨折术式量化评分表与临床实践具有一致性，对内固定、全髋关节置换及半髋关节置换手术方式的选择具有较明显的指导意义。

Objective To evaluate the consistency and clinical value of a self-designed quantitative scale used in treatment of adult femoral neck fractures. Methods Seven hundred patients with femoral neck fracture were reviewed who had been treated in our hospital from January 2007 to April 2010. Five hundred and two patients were included in this study according to the inclusion criteria of our self-designed quantitative scale. All the 502 cases were divided into 4 groups according to their scale scores and actual treatment： low score internal fixation group （LSIF） （281 cases）, total hip replacement group （THA） （94 cases）, hemiarthroplasty group （HA） （119 cases）, and high score internal fixation group （HSIF） （8 cases）. Each group was further divided into a consistency sub-group and an inconsistency sub-group according to the consistency between their actual treatments and scale scores. The operative time, blood loss, blood transfusion, infection rate, re-operation rate, mortality rate, Harris hip score were compared between the consistency sub-group and inconsistency sub-group in LSIF, THA and HA groups respectively. Results The 502 patients were followed up for 1.0 to 4.5 years （average, 3.2 years） . The Kappa value of 0. 549（ P =0. 000） by the consistency test indicated the quantitative scale was consistent with actual clinical treatments. In the LSIF group, the nonunion rate, femoral head necrosis rate and re-operation rate in the consistency sub-group were significantly lower than in the inconsistencysub-group （1.2% vs. 17.9%, 7.4% vs. 33.3%, 7.0% vs. 41.0%, respectively）, but the Harris hip score were significantly higher （86.4 ±9.9 vs. 74.8 ± 10.8） （ P 〈 0.05） . In the THR group, the revision rate and Harris hip score were significantly different between the consistency sub-group and the incon- sisteneysub-group, favoring the former（1. 6% vs. 18.2%, 92.0±6.3 vs. 85.9-±11.6, respectively） （P 〈 0.05）. In the HA group, the revision rate in the consistency sub-group （5.5%） was significantly lower than in the inconsistency sub-group（18.8% ） （Х^2 =4. 746, P=0. 029） . Conclusion Since our self-designed quantitative scale is an instrument highly consistent with clinical treatments, it is of great value in surgical decision-making for treatment of adult femoral neck fractures.