老年股骨颈骨折患者内固定术后发生股骨头坏死的危险因素

Risk factors analysis of femoral head necrosis in elderly femoral neck fracture patients after internal fixation

目的探讨老年股骨颈骨折患者经闭合复位内固定治疗后股骨头坏死的发生率及危险因素。方法选取行闭合复位内固定治疗的192例老年股骨颈骨折患者病例资料。统计术后股骨头坏死的发生率,并将患者分为股骨头坏死组(36例)和无股骨头坏死组(156例)。收集患者性别、年龄、基础疾病、骨折侧别、骨折分型、受伤至手术时间、复位质量、内固定物是否取出等影响因素,采用单因素和Logistic多因素分析股骨头坏死的危险因素。结果 192例患者术后随访1~3年,36例(18.8%)发生股骨头坏死,发生时间为(1.1±0.4)年。单因素分析显示:高龄、高骨折分型、受伤至手术时间>1周、复位质量差、内固定物未取出是患者发生股骨头坏死的危险因素。Logistic回归分析显示:骨折移位、受伤至手术时间>1周、复位质量差、内固定物取出是患者发生股骨头坏死的独立危险因素。结论内固定术后老年股骨颈骨折患者易发生股骨头坏死,而骨折移位、受伤至手术时间>1周、复位质量差、内固定物取出是患者发生股骨头坏死的独立危险因素。

Objective To investigate the risk factors of femoral head necrosis in elderly femoral neck fracture patients after internal fixation, and provide scientific reference for clinical treatment and prevention. Methods 192 ca-ses of elderly femoral neck fracture patients treated by closed reduction and internal fixation were retrospectively ana-lyzed. The femoral head necrosis ratio of patients was account,and patients were divided into femoral head necrosis group （36 cases） and non femoral head necrosis group （ 156 cases） . The clinical data of gender,age,underlying diseases,frac-tures lateralization,fracture type,injury to surgery time,reduction quality,and internal fixation taken out or not were se-lected. And univariate and Logistic multifactor analysis were carried out to analysis risk factors. Results All patients were followed-up for 1 to 3 years, 36 cases （18. 8% ） occurred femoral head necrosis, and the occurrence time was （1. 1 ±0.4） years. Univariate analysis showed： age, male, high fracture type’injury to surgery time 〉 1 week, poor reduc-tion quality, internal fixation not taken out were the risk factors of femoral head necrosis in patients. Logistic multivariate analysis showed that：fracture displacement,injury to surgery time 〉 1 week,poor reduction quality,internal fixation taken out were the independent risk factor of femoral head necrosis in patients. Conclusion The elderly patients with femoral neck fractures after internal fixation are likely to occurre femoral head necrosis,and fracture displacement,injury to surgery time 〉1 week,poor reduction quality,internal fixation taken out are the independent risk factor of femoral head necrosis.