成人股骨颈骨折术后股骨头坏死高危因素分析

Analysis of high risk factors on femoral head necrosis after femoral neck surgery in adult patients

目的 探讨多枚空心加压螺钉治疗成人股骨颈骨折术后股骨头坏死的高危因素。方法 选择本院2009年1月至2014年10月收治的390例股骨颈骨折患者为研究对象,采取多枚空心加压螺钉治疗,随访12~60个月,回顾性分析患者临床资料,包括患者年龄、性别、骨折侧别、Garden指数、骨折移位情况、内科合并症、术前是否行牵引、复位方法、术后开始负重时间和空心加压螺钉内固定是否取出等资料,统计术后股骨头坏死发生率,分析成人股骨颈术后股骨头坏死高危因素。结果 352例患者获得随访,随访率90.3%,其中骨折不愈合45例,股骨头坏死49例。单因素回归分析结果显示,患者年龄、骨折移位情况、内科合并症及术后开始负重时间、Garden指数、内固定是否取出均为股骨头坏死的危险因素（P〈0.05）。多因素Logistic分析结果显示,年龄40~60岁、骨折发生移位、有严重内科合并症、术后开始负重时间小于3个月、Garden指数Ⅲ~Ⅳ级、内固定物取出均为股骨颈骨折术后股骨头坏死的高危因素（P〈0.05）。结论 年龄40~60岁、骨折发生移位、有严重内科合并症、过早负重、Garden指数较高、取出内固定物等因素会增加股骨头坏死和塌陷的风险。

Objective To evaluate the potential high risk factors of femoral head necrosis after femoral neck surgery, in adult patients. Methods From January 2009 to October 2014,390 patients with femoral neck fractures in our hospital were treated with multiple hollow compression screws. All patients were followed up for 12 to 60 months. Then retrospectively analyzed the incidence rates of femoral head nec- rosis and the clinical data about age,gender,fracture side, Garden index, fracture shift condition,internal medicine complications, whether to do lower limb preoperative traction, restoration method, postoperative load time and whether take out hollow compression screw internal fixa- tion, so as to explore the higher risk factors for femoral head necrosis. Results Among the 390 cases, 352 cases got followed up. There were 45 cases of them ended with nouunionand 49 cases ended with femoral head necrosis. The univariate regression analysis results showed that the age ,fracture shift condition, internal medicine complications, postoperative load time and Garden index ,whether take out internal fixation were risk factors for femoral head necrosis （ P 〈 0.05 ）. The multi-factor results showed that aged from 40 to 60 years old, transfered fracture, seriously complications,time of loading less than 3 mouths, Ⅲ and Ⅳ Garden index,take out internal fixation were the high risk factors for femoral head necrosis （ P 〈 0.05 ）. Conclusion Patients who aged from 40 to 60 years old and having trausfered fracture, seriously complication,early weight bearing,high Garden index and internal fixation take-out would increase the risk of femoral head necrosis.