股骨颈骨折加压螺钉取出术后继发股骨头缺血坏死的原因分析

Analysis of the causes of femoral head necrosis after femoral neck fracture healing and implant removal

目的对股骨颈骨折加压螺钉内固定术后骨愈合后,内固定取出术后继发股骨头缺血坏死的因素进行分析,探讨最佳的治疗方案。方法回顾性分析2008年7月至2016年7月期间,因股骨颈骨折加压螺钉内固定术后骨愈合行内固定取出术而入我院创伤外科住院患者,共有71例纳入研究。其中男性32例,女性39例。年龄13～80岁,平均56.48岁。随访期间,对继发股骨头缺血坏死和未继发股骨头缺血坏死患者的年龄、性别、骨折类型、受伤后至手术病程、复位质量、加压螺钉取出时机、加压螺钉取出后钉道是否植骨以及加压螺钉取出后患肢负重时间等因素进行分析。结果平均随访35.62个月(24个月～62个月),在随访期间,经临床症状和影像学评估证实继发股骨头缺血坏死病例23例,未继发股骨头缺血坏死病例48例。单因素分析显示:年龄,骨折类型,受伤后至手术病程、复位质量、加压螺钉取出时机、加压螺钉取出后钉道是否植骨以及加压螺钉取出后患肢负重时间(P <0.05)与加压螺钉取出后是否继发股骨头缺血性坏死相关,而性别与此无明显关(P> 0.05)。多因素回归分析进一步表明,年龄(OR=2.072)、骨折类型(OR=0.059)、复位质量(OR=41.968)、加压螺钉取出时机(OR=0.000)以及加压螺钉取出后患肢负重时间(OR=0.000)是加压螺钉取出后是否继发股骨头缺血性坏死的独立危险因素(P <0.05)。结论患者年龄、骨折类型、复位质量、加压螺钉取出时机和加压螺钉取出后患肢负重时间是影响股骨颈骨折加压螺钉取出术后继发股骨头缺血坏死的重要危险因素,对股骨颈骨折加压螺钉取出术患者的治疗具有指导意义。

Objective To explore the factors related to femoral head necrosis after femoral neck fracture healing and implant removal.Methods A total of 71 patients with the healing of femoral neck fracture who were removed the implant in Guangzhou Red Cross Hospital and effective follow-up between July2008 and July 2016 were reviewed retrospectively,including 32 males and 39 females with an average age of 56.48(range,13 to 80).The incidence of the femoral head necrosis was recorded and the factors such as age,gender,fracture type,interval from injury to surgery,the quality of facture reduction,the timing to remove the internal fixation,bone graft in screw path or not and the time of weight bearing were analyzed.Results the factors which included age,fracture type,interval from injury to surgery,the quality of fracture reduction,the timing to remove the internal fixation,bone graft in screw path or not and the time of weight bearing were related to the development of femoral head necrosis after femoral neck fracture healing and implant removal(P<0.05),while the gender had no relationship with it(P>0.05).Multi-variate analysis confirmed that the factors including age(OR=2.072),fracture type(OR=0.059),the quality of fracture reduction(OR=41.968),the timing to remove the internal fixation(OR=0.000)and the time of weight bearing(OR=0.000)were independent factors(P<0.05).Conclusion The fac-tors which included age,fracture type,the quality of fracture reduction,the timing to remove the internal fixation and the time of weight bearing are confirmed as the relevant risk factors for the development of the femoral head ne-crosis after femoral neck fracture healing and implant removal.