中青年股骨颈骨折内固定术后股骨头坏死的相关因素

Risk factors of femoral head necrosis after internal fixation for femoral neck fracture in the young and middleaged

[目的]探讨中青年股骨颈骨折闭合复位空心钉内固定术后股骨头坏死的相关因素及MRI的应用价值。[方法]回顾本科2012年1月～2017年1月闭合复位空心钉内固定术的208例中青年股骨颈骨折资料,比较MRI及X线片对术后股骨头坏死的检测结果,分析性别、年龄、Garden分型、是否急诊、骨折复位质量与术后是否发生股骨头坏死的相关性。[结果] 208例患者随访12～68个月,平均(28.12±9.04)个月,全部完成X线片随访检查,X线片检出43例(20.67%)坏死。其中158例完成规范的MRI,MRI检出102例(64.56%)坏死。208例患者中MRI和(或) X线片共检出110例(52.88%)。MRI的检出率高于X线片,差异具有统计学意义(P<0.05)。单因素比较显示坏死组与非坏死组在性别、是否急诊与术后股骨头坏死的差异无统计学意义(P>0.05),而在年龄、Garden分型、骨折复位质量的差异有统计学意义(P<0.05)。[结论]中青年股骨颈骨折空心钉内固定术后股骨头坏死是多因素影响的结果,其中年龄、Garden分型、骨折复位质量是相关危险因素,而性别、是否急诊关系不密切。

[Objective] To explore risk factors of femoral head necrosis after internal fixation for femoral neck fracture in the young and middle-aged. [Methods] A retrospective study was conducted on 208 young and middle-aged patients who underwent closed reduction and internal fixation with cannulated screws for femoral neck fracture between January 2012 and January 2017. The MRI and X-ray films were taken for detection of femoral head necrosis, additionally, relative factors to femoral head necrosis was searched, including gender, age, Garden classification, whether or not operation conducted in emergency and reduction quality. [Results] The 208 patients were followed up from 12 to 68 months with a mean of （28.12±9.04） months. All the patients received complete X-ray checks, which revealed femoral head necrosis in 43 patients （20.67%）. By contrast, 158 patients of them had complete MRI examination performed, which demonstrated femoral head necrosis in 102 patients （64.56%）. Of the 208 patients, a total of 110 patients （52.88%） were found femoral head necrosis by MR/and / or X-ray films. The MRI proved significantly more sensitive than X-rays for detection of femoral head necrosis （P〈0.05）. Single factor comparisons showed that no statistically significant differences between the patients with or without femoral head necrosis in gender and whether or not operation performed in emergency （P〉0.05）, however, statistically signcantly differences were proved in age, Garden classification and reduction quality （P〈0.05） . [Conclusion] Femoral head necrosis is the result of many factors in young and middle-aged patients received closed reduction and internal fixation with carmulated screws for femoral neck fracture. The age, Garden classification and reduction quality is closely related to femoral head necrosis, whereas gender, whether or not operation performed in emergency is not relative factor in the study.