股骨颈骨折复位内固定术后股骨头坏死的相关因素分析

Multivariate correlation analysis of femoral head necrosis after operation of femoral neck fracture

目的分析股骨颈骨折复位内固定术后股骨头坏死的相关因素。方法回顾性分析2012年1月至2015年1月采用股骨颈骨折复位内固定术治疗524例患者资料，以股骨头坏死作为观测指标，将术后发生股骨头坏死与同期未发生坏死的患者临床资料进行对比，应用单因素卡方检验分析性别、年龄、手术复位方式、骨折类型、复位质量、受伤至手术时间、术后负重时间、内固定是否取出等因素与股骨颈骨折复位内固定术后股骨头发生坏死的相关性，将有统计学意义的指标再行多因素Logistic回归，从而确定影响术后股骨头坏死的相关因素。结果根据纳入和排除标准，212例患者纳入研究，男94例，女118例；随访时间2-5年，平均（3．6±1．6）年。其中46例发生股骨头坏死，166例未发生坏死，股骨头坏死发生率为21．7％（46／212）。股骨头坏死组46例，男21例，女25例；60岁以下患者20例，以上患者26例；采用切开复位治疗17例，闭合复位治疗29例；骨折Garden分型的Ⅰ、Ⅱ型6例，Ⅲ、Ⅳ型40例；复位满意16例，复位不良30例；受伤至手术时间≤48h30例，〉48h16例；术后负重时间≤3个月17例，〉3个月29例；内固定取出22例，未取出24例。股骨头未坏死组166例，男73例，女93例；60岁以下患者84例，以上患者82例；采用切开复位治疗69例，闭合复位治疗98例；骨折Gar—den分型Ⅰ、Ⅱ型120例，Ⅲ、Ⅳ型46例；复位满意160例，复位不良6例；受伤至手术时间≤48h119例，〉48h47例；术后负重时间≤3个月70例，〉3个月96例；内固定取出74例，未取出92例。单因素卡方检验示骨折类型、复位质量与术后股骨头坏死有相关性，而性别、年龄、手术复位方式、受伤至手术时间、术后负重时间和内固定是否取出与术后股骨头坏死无关。多因素Logistic回归分析示骨折类型、复位质量与术后股骨头坏死显著相关。结论股骨颈骨折复位内固定术后股骨头坏死的发生受多种因素影响，其中骨折类型和复位质量是影响股骨颈骨折复位内固定术后股骨头坏死的重要因素。

Objective To analyze the related factors of femoral head necrosis after internal fixation operation of femoral neck fracture. Methods Clinical data of 524 patients with femoral neck fracture who underwent internal fixation surgery between January 2012 and January 2015 were retrospectively analyzed. Taking the femoral head necrosis as an observable indicator, the clinical data of postoperative femoral head necrosis and those other patients who were treated at the same period were compared. Whether the clinical factors （gender, age, surgical reduction type, fracture type, quality of reduction, post-injury operation time, loading time after operation, and whether to withdraw internal fixation） were in correlation with postoperative femoral head necro- sis was analyzed by univariate analysis. Then the statistically significant indicators were integrated into logistic regression analysis to determine the related factors of femoral head necrosis. Results According to inclusion and exclusion criteria, the study group consisted of 212 cases, including 94 males and 118 females; the follow-up time was 2-5 years, and the average follow-up time was 3.6＋1.6 years. There were 46 cases with femoral head necrosis and 166 cases without femoral head necrosis after operation. The rate of femoral head necrosis was 21.7% （46/212）. The femoral head necrosis group included 46 cases with 21 males and 25 fe- males; 20 cases below 60 years old and 26 cases above 60 years old; 17 cases using open reduction and 29 cases using closed reduction; 6 cases belong to type Ⅰ/Ⅱ and 40 cases belong to type Ⅲ/Ⅳ according to Garden classification; 16 cases got satisfactory reduction while 30 cases with unsatisfactory reduction; 30 cases below 48 h and 16 cases above 48 h on post-injury operation time; 17 cases below 3 months and 29 cases above 3 months on post-operation loading time; 22 cases with internal fixation removal and 24 cases without internal fixation removal. The femoral head without necrosis group included 166 cases with 73 males and 93 females; 84 cases below 60 years old and 82 cases above 60 years old; 69 cases using open reduction and 98 cases using closed re-duction; 120 cases belong to type Ⅰ/Ⅱ and 46 cases belong to type Ⅲ/Ⅳ according to Garden classification; 160 cases got satisfac- tory reduction while 6 cases with unsatisfactory reduction; 119 cases below 48 h and 47 cases above 48 h on post-injury operation time; 70 cases below 3 months and 96 cases above 3 months on post-operation loading time; 74 cases with internal fixation removal and 92 cases without internal fixation removal. Univariate A2 analysis suggested that fracture type and quality of reduction were associated with postoperative femoral head necrosis. Other clinical factors （gender, age, surgical reduction type, post-injury operation time, loading time after operation and whether to remove internal fixation or not） were not associated with postoperative femoral head necrosis. The multivariate Logistic regression analysis showed fracture type and quality of reduction were significantly related to postoperative femoral head necrosis. Conclusion Femoral head necrosis after internal fixation operation of femoral neck fracture is affected by many factors. The fracture type and quality of reduction are important factors affecting femoral head necrosis after internal fixation operation of femoral neck fracture.