65岁以下股骨颈骨折术后股骨头坏死的多因素分析

Retrospective analysis of factors affecting prognosis after percutaneous osteosynthesis of femoral neck fractures in patients younger than 65 years old

[目的]探索影响65岁以下股骨颈骨折经闭合复位空心钉治疗术后发生股骨头坏死的相关因素,为进一步优化治疗提供询证依据。[方法]对2008年6月～2009年12月本院收治的138例65岁以下股骨颈骨折后行闭合复位空心钉内固定术的病例进行回顾性分析。符合纳入标准共97例,使用SPSS 17.0对其围手术期BMI,术前牵引,Pauwels分型,术前骨折移位,空心钉数量五个因素进行统计分析,评估其与术后愈合情况的关系。[结果]97例患者末次随访均为2012年6月后,其中股骨头坏死15例,坏死率为15.5%。围手术期BMI,术前牵引,Pauwels分型,术前骨折移位与股骨颈骨折术后股骨头坏死有相关性。其中围手术期BMI,Pauwels分型和术前骨折移位构成的多因素组对股骨颈骨折术后股骨头坏死影响最为显著。[结论]股骨颈骨折本身的因素,Pauwels分型及术前骨折移位对股骨颈骨折术后愈合有很大的影响;BMI可能通过影响骨折局部应力及血脂水平来影响预后。

[ Objective ] To investigate the factors correlated to femoral head necrosis in patients younger than 65 years old after percutaneous osteosynthesis of femoral neck fractures. [ Method] Totally 138 patients younger than 65 years old with femo- ral neck fracture, treated with closed reduction and internal fixation were admitted from June 2008 to December 2009. The BMI （body mass index） , preoperative traction, Pauwels classification, fracture displacement and the number of screws were analyzed by SPSS19.0 statistic system to evaluate the correlation. [ Result] Complete case records were documented in 97 cases that the latest follow-up was after June 2012. Femoral head necrosis occurred in 15 cases（ 15.5% ）. The combination of BMI,Pauwels classification and fracture displacement was found to have the most significant influence on the femoral head necrosis after internal fixation for femoral neck fractures. [ Conclusion ] Pauwels classification and fracture displacement are the most important factor correlated to the outcome of a femoral neck fracture. BMI may affect the patient＇ s pelvitrochanteric muscle and level of lipidemia to be associated with femoral head necrosis.