螺钉内固定治疗PauwelsⅢ型股骨颈骨折发生股骨头缺血性坏死的影响因素

Influential factors on femoral head avascular necrosis after screw internal fixation for femoral neck fracture of Pauwels type Ⅲ

背景:近年来PauwelsⅢ型骨折发病率升高,并未明确治疗方案,且术后较PauwelsⅠ、Ⅱ型骨折易发生股骨头缺血性坏死,分析其相关危险因素对于预防术后股骨头缺血性坏死具有重要意义。目的:探讨PauwelsⅢ型股骨颈骨折螺钉内固定后股骨头缺血性坏死的影响因素。方法:回顾性分析2010年1月到2016年12月中山市中医院收治并接受手术治疗的216例PauwelsⅢ型股骨颈骨折患者的临床资料,采用单因素及Logistic多因素回归分析股骨颈骨折空心拉力螺钉内固定术后股骨头缺血性坏死的相关危险因素。所有患者对治疗及调查方案知情同意,且得到医院伦理委员会批准。结果与结论:①216例股骨颈骨折螺钉内固定后患者的股骨头缺血坏死发生率为12.5%;②患者性别、体质量指数、骨折至手术时间、是否伴有糖尿病、是否伴有高血压与股骨颈骨折螺钉内固定后股骨头缺血性坏死的形成无关(P>0.05),而患者年龄、是否术前牵引、手术方式、复位质量、完全负重时间、内固定取出时间均是股骨颈骨折螺钉内固定后股骨头缺血性坏死的相关因素(P<0.05);③患者年龄大于55岁、术前牵引、空心螺钉内固定、GardenⅢ、Ⅳ型复位质量、术后3个月内完全负重均是导致股骨颈骨折螺钉内固定后股骨头缺血性坏死的危险因素(P<0.05);④提示PauwelsⅢ型股骨颈骨折螺钉内固定后股骨头缺血性坏死的危险因素包括患者年龄大于55岁、术前牵引、空心螺钉内固定、GardenⅢ、Ⅳ型复位质量、术后3个月内完全负重,有效控制这些因素可以减少和预防内固定术后股骨头缺血性坏死的发生。

BACKGROUND: In recent years, the incidence of Pauwels type Ⅲ fractures has increased, and the treatment plan is not clear, and the avascular necrosis of femoral head is easy to occur after surgery compared with Pauwels type Ⅰ and Ⅱ fractures. Analysis of related risk factors is of great significance for preventing avascular necrosis of femoral head after surgery. OBJECTIVE: To evaluate the influential factors for femoral head avascular necrosis after screw internal fixation for femoral neck fracture of Pauwels type Ⅲ. METHODS: Clinical data of 216 patients with Pauwels type Ⅲ femoral neck fracture who were admitted to Zhongshan Hospital of Traditional Chinese Medicine from January 2010 to December 2016 were analyzed retrospectively. Risk factors related to femoral head avascular necrosis after screw internal fixation were evaluated by univariate and multivariate logistic regression analysis. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. RESULTS AND CONCLUSION:(1) In 216 patients with femoral neck fracture of screw fixation, the incidence of the femoral head avascular necrosis was 12.5%.(2) The sex, body mass index, fracture to surgery time, presence of diabetes, hypertension, and femoral head avascular necrosis had no obvious correlation(P > 0.05). The patient’s age, preoperative traction, surgical plan, reset quality, full load time, and internal fixation removal time were all related factors for the femoral head avascular necrosis after screw internal fixation for femoral neck fracture(P < 0.05).(3) The age greater than 55 years old, preoperative traction, hollow screw internal fixation, Garden Ⅲ, type IV reset quality, and complete weight bearing within 3 months after surgery were risk factors for the femoral head avascular necrosis after screw internal fixation for femoral neck fracture(P < 0.05).(4) The risk factors of the femoral head avascular necrosis after screw internal fixation for femoral neck fracture of Pauwels type Ⅲ are the age greater than 55 years old, preoperative traction, hollow screw internal fixation, Garden Ⅲ, type IV reset quality, and complete weight bearing within 3 months after surgery. Effective control of these factors can reduce and prevent postoperative avascular necrosis of the femoral head.