空心钉锁定板治疗股骨颈骨折术后股骨头坏死的危险因素分析

The risk factors of femoral head necrosis after treatment with femoral neck fractures with locking plate and cannulated screw

目的：探讨股骨头骨折患者内固定术后股骨头坏死（ONFH）的相关危险因素。方法选择该科2010～2012年符合研究要求的股骨颈骨折患者126例，分为ONFH组和对照组，比较两组患者的一般情况、骨折发生情况、骨折治疗情况等方面的差异。结果空心钉锁定板治疗股骨颈骨折患者126例，发生ONFH者17例，患病率为13．49％（17／126）。单因素分析显示，年龄、骨折移位程度分型、受伤至手术间隔时间、复位质量、内固定螺钉位置、是否取出内固定是ONFH的影响因素，差异有统计学意义（P＜0．05）；广义线性模型分析显示，年龄与内固定是否取出、性别与受伤至手术间隔存在交互作用（F＝5．768，P＝0．018；F＝5．542，P＝0．020）；多因素Logistic回归分析显示，年龄、复位质量、受伤至手术间隔时间、性别与受伤至手术间隔是ONFH的危险因素，OR值分别为0．215、0．293、3．162、3．054。结论年龄较大的股骨颈骨折患者，早期实施空心钉锁定板手术，解剖复位好，ONFH发生的可能性小。

Objective To investigate the risk factors of influencing femoral head necrosis （ONFH） after treatment with internal fixation of femoral head fracture .Methods 126 patients with femoral neck fracture admitted from 2010 to 2012 in the hospital ,and treated by locking plate and cannulated screw ,were divided into the ONFH group and the control group .Patient condition ,fracture situation ,fracture treatment .etc were compared between the two groups .Results Among 126 patients with femoral neck fracture treated by locking plate and cannulated screw ,17 cases in the ONFH group were founded ,the prevalence rate of ONFH was 13 .49% （17/126） .Univariate analysis showed that ,age ,garden type ,quality of reduction ,injury-to-surgery interval ,screw place-ment ,whether to remove the internal fixation were influencing factors ,the difference was statistically significant （P＆lt;0 .05） .Gener-alized linear model analysis showed that there was interaction between age and internal fixation ,gender and injury-to-surgery （F=5 .768 ,P=0 .018 ;F=5 .542 ,P=0 .020） .Multiple Logistic regression analysis showed that ,age ,quality of reduction ,injury-to-sur-gery interval ,gender and injury-to-surgery were risk factors of ONFH ,OR were 0 .215 ,0 .293 ,3 .162 ,3 .054 ,respectively .Conclu-sion The elderly patient with femoral neck fracture treated by locking plate and cannulated screw early with excellent anatomic re-duction ,has less incidence of ONFH .