颈垂角与空心螺钉内固定治疗股骨颈骨折远期预后的相关性研究

Vertical Neck angle and long.term outcomes of femoral neck fractures treated with cannulated screws

目的探讨空心螺钉内固定治疗的新鲜股骨颈骨折远期预后与基于颈垂角（VN）的VN分型之间的关系。方法回顾性研究2012年1月至2014年12月上海交通大学附属第六人民医院骨科采用3枚空心螺钉治疗的162例新鲜股骨颈骨折患者资料，采用logistic回归分析内固定失败、骨折不愈合、股骨头坏死（ONFH）等长期并发症与VN分型的相关性。结果所有患者术后获6～36个月（平均25．7个月）随访。151例患者骨折获愈合，平均愈合时间为4．5个月（3-9个月）。患者发生内固定失败23例，股骨颈骨折不愈合11例，ONFH21例，股骨头塌陷13例。相关性分析logistic回归检验结果显示内固定失败、骨折不愈合、ONFH发生与性别、年龄、复位方式均无关（P〉0．05）；内固定失败（P〈0．001）、骨折不愈合（P=0．001）的发生与VN分型均有明显的相关性，而ONFH发生与VN分型相关性不明显（P=0．109）。结论VN分型作为一种新的股骨颈骨折的分型方法，与骨折内固定失败及骨折不愈合有较强的相关性。

Objective To analyze the associations between long-term outcomes of fresh femoral neck fractures treated with cannulated screws and the classification based on vertical neck （VN） angle. Methods A retrospective study was conducted of the 162 fresh femoral neck fractures treated with 3 cannulated screws at Department of Orthopaedics, The Sixth People＇s Hospital of Shanghai from January 2012 to December 2014. The relationships were analyzed using Logistic Regression between long-term complications and VN classifi- cation, including fixation failure, fracture nonunion and osteonecrosis of femoral head （ONFH）. Results All the patients were followed up for an average of 25.7 months （from 6 to 36 months） . Of them, 151 ob- tained fracture union after an average of 4.5 months （from 3 to 9 months）. Internal fixation failure occurred in 23 cases, nonunion of femoral neck in 11, ONFH in 21 and femoral neck collapse in 13. Logistic Regression analysis showed no significant associations between internal fixation failure, nonunion or ONFH and gender, age or reduction method （ P 〉 0. 05 ） but significant associations of VN classification with fixation failure （ P 〈 0. 001 ） and nonunion （ P = 0. 001 ） and insignificant association of VN classification with ONFH （ P = 0. 109）. Conclusion VN classification, a new classification method for femoral neck fractures, may be closely related with incidences of fixation failure and nonunion.