股骨颈骨折内固定术后随访资料的Harris评分分析

ANALYSIS ON HARRIS SCORES AT FOLLOW-UP AFTER INTERNAL FIXATION OF FEMORAL NECK FRACTURE

目的探讨股骨颈骨折内固定术后随访资料中不同变量的Harris评分及Harris评分等级的影响因素。方法回顾分析1999年5月-2004年5月采用闭合复位空心钉治疗的99例股骨颈骨折患者临床资料,就年龄、性别、骨折类型(Garden分型)、复位时间、复位质量(Garden指数)、完全负重时间、内固定是否取出、术前是否牵引、骨折侧别、股骨头是否坏死、随访时间以及随访时Harris评分等因素进行术后随访调查。应用SPSS14.0和SAS8.2统计软件包进行单因素和多因素统计分析。结果P-P概率图和正态性检验得出Harris评分呈偏态分布(W=0.75709,P=0.0001)。单因素分析中,非参数检验得出对Harris评分影响有统计学意义的变量有复位时间(U=—2.289,P=0.022)、Garden分型(H=16.943,P=0.001)、完全负重时间(U=—3.069,P=0.002)、复位质量(U=—3.448,P=0.001)、股骨头是否坏死(U=—4.723,P=0.000)。等级相关分析得出有统计学意义的变量有Garden分型(rs=—0.412,P=0.000)、复位时间(rs=—0.231,P=0.021)、复位质量(rs=—0.348,P=0.000)、完全负重时间(rs=—0.310,P=0.002)、股骨头是否坏死(rs=—0.477,P=0.000)。单因素logistic回归分析得出对Harris评分影响有统计学意义的变量有Garden分型(P=0.0001)、复位时间(P=0.0126)、复位质量(P=0.0003)、完全负重时间(P=0.0032)、术前是否行牵引(P=0.0492)及股骨头是否坏死(P=0.0001)。多因素logistic逐步回归分析得出股骨头是否坏死(P=0.0001)、复位时间(P=0.0282)和Garden分型(P=0.0007)是Harris评分等级的影响因素。结论Harris评分呈偏态分布,股骨头坏死是股骨颈骨折术后功能最主要的影响因素。

Objective To investigate the specific variables and influence factors of Harris scores in follow-up data of patients with internal fixation of femoral neck fracture. Methods From May 1999 to May 2004, 99 cases of femoral neck fracture receiving close reduction with cannulated screw and having complete follow-up data were evaluated in terms of age, sex, type of bone fracture （Garden classification）, reduction time, reduction qual ity （Garden indicators）, time of full weight-loading, removal of internal fixation, traction before operation, side of bone fracture, necrosis of femoral head, duration of follow-up and Harris score during follow-up period. Univariate and multivariate were analyzed by SPSS14.0 and SAS8.2. Results P-P probabil ity plot and normal test revealed the Harris scores were non-normal distribution （W=0.757 09, P=0.000 1）. By nonparametric test in univatiate analysis, the following variables in Harris scores were of statistic significance： the time of reduction （U=- 2.289, P=0.022）, the Garden classifaction （H=16.943, P=0.001）, the time of full weight-bearing （U=- 3.069, P=0.002）, the qual ity of reduction （U=- 3.448, P=0.001） and the necrosis of femoral head （U=- 4.723, P=0.000）. By the analysis of correlation, the following variables in Harris scores were of statistic significance： Garden classification（rs=- 0.412, P=0.000）, the time of reduction （rs=- 0.231, P=0.021）, the qual ity of reduction （rs=- 0.348, P=0.000）, the time of full weight-bearing （rs=- 0.310, P=0.002）, and the necrosis of femoral head （rs=- 0.477, P=0.000）. By the univariate logistic regression analysis, the following variables in Harris scores were of statistic significance： Garden classification （P=0.000 1）, the time of reduction （P=0.012 6）, the qual ity of reduction （P=0.000 3）, the time of full weight-bearing （P=0.003 2）, the traction before operation （P=0.049 2） and the necrosis of femoral head （P=0.000 1）. By the multivariate logistic regression analysis, the influence factors of Harris scores rank included the necrosis of femoral head （P=0.000 1）, the time of reduction （P=0.028 2）, and Garden classification （P=0.000 7）. Conclusion Harris scores is of non-normal distribution, and the necrosis of femoral head is the most important factor influencing the function after applying internal fixation with cannulated screws to femoral neck fracture.