闭合复位空心螺钉治疗股骨颈骨折后股骨头坏死的影响因素分析

Analysis of influencing factors related to femoral head necrosis after closed reduction and internal fixation with hollow screws

目的回顾性分析闭合复位空心螺钉治疗股骨颈骨折后股骨头坏死的影响因素。方法对2009年1月至2017年3月293例采用加压空心螺钉治疗股骨颈骨折的患者进行回顾性分析,其中获得随访的患者247例。应用SPSS20.0软件进行统计学分析,并对影响股骨头坏死的各项因素进行Logistic回归分析。结果247例患者获得平均58个月(24~80个月)随访,32例出现股骨头坏死,发生率12.9%,随访时髋关节Harris评分平均81.4±3.9分(54~98分)。影响股骨颈骨折术后股骨头坏死的因素和顺序依次为复位质量(OR=9.854,P=0.012),空心钉排列方式(OR=7.965,P=0.017),骨折分型(OR=6.453,P=0.021),空心钉取出与否(OR=5.364,P=0.027),术前是否牵引(OR=2.561,P=0.042)。结论复位质量是影响股骨颈骨折预后最为关键的因素。空心螺钉正三角形排列、空心螺钉取出以及未及时术前牵引均可能加重股骨头坏死。

Objective To retrospectively study the influencing factors of femoral head necrosis after treatment of femoral neck fractures with closed reduction and internal fixation with compressive hollow screws.Methods A total of 247 patients with complete clinical data out of 293 patients with femoral neck fractures treated by closed reduction and internal fixation with compressive hollow screws from January 2009 to March 2017 were included in the study.Multiple correlation factors were analyzed by SPSS 20.0 statistic system.Logistic multiple regression method was used to analyse the influencing factors of femoral head necrosis.Results All the 247 patients obtained a mean follow-up of 58 months(24 to 80 months).Femoral head necrosis occurred in 32cases(12.9%).The total average Harris score for this series was 81.4±3.9 points(54 to 98).Factors that might have an impact on necrosis of femoral head were ranked in the following likelihood sequence:quality of reduction(OR=9.854,P=0.012),arrangement of hollow screws(OR=7.965,P=0.017),fracture type(OR=6.453,P=0.021),screw removal or not(OR=5.364,P=0.027),preoperative traction(OR=2.561,P=0.042).Conclusion Quality of reduction is the most important factor that influences the prognosis.Triangle configuration of hollow screws,screws removal and no timely traction can increase the incidence of necrosis.