股骨颈骨折多枚空心加压螺钉内固定术后股骨头坏死的影响因素分析

Influencing factors of femoral head necrosis after internal fixation with multiple hollow compression screws for femoral neck fractures

目的探讨股骨颈骨折多枚空心加压螺钉内固定术后股骨头坏死(ONFH)发生率并分析其影响因素。方法对我院108例股骨颈骨折患者进行随访,统计ONFH发生率,并根据是否发生ONFH将患者分为坏死组(n=27)和未坏死组(n=81)。单因素χ^(2)检验比较2组患者相关因素的差异,多因素Logistic回归模型分析ONFH的独立影响因素。采用受试者工作特征(ROC)曲线分析独立影响因素和联合模型对ONFH的预测作用,基于AMOS软件构建ONFH的结构方程模型。结果经MRI、X射线检测出27例(25.00%)ONFH患者。单因素χ^(2)检验结果显示,2组骨折原因、Garden分型、受伤距手术时间、螺钉排列方式、螺钉取出与否及复位质量比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,Garden分型Ⅲ~Ⅳ级、螺钉排列方式为正三角形、螺钉取出及复位质量Ⅲ~Ⅳ级均是ONFH发生的独立影响因素(P<0.05)。独立影响因素联合模型的曲线下面积(AUC)为0.809(95%CI0.728~0.836)。结构方程模型中Garden分型、螺钉排列方式、螺钉取出与否及复位质量的路径系数分别为0.118、0.104、0.097、0.135,模型可决系数为0.28。结论Garden分型、螺钉排列方式、螺钉取出与否及复位质量均是股骨颈骨折患者内固定术后并发ONFH的独立影响因素,能解释部分ONFH变异度,联合独立影响因素模型对ONFH进行预测价值更高。

Objective To investigate the incidence of osteonecrosis of the femoral head(ONFH)after internal fixation with multiple hollow compression screws for femoral neck fractures and its influencing factors.Methods A total of 108 patients with femoral neck fractures in our hospital were followed up.The incidence of ONFH was counted,and the patients were divided into the necrotic group(n=27)and the non-necrotic group(n=81)according to the occurrence of ONFH.The univariateχ^(2) test was used to compare the difference in related factors between the two groups,and the multivariate Logistic regression model was used to analyze the independent influencing factors of ONFH.The receiver operating characteristic(ROC)curve was used to analyze the predictive effects of the independent influencing factors and the combined model on ONFH,and the structural equation model of ONFH was established based on the AMOS software.Results A total of 27 cases(25.00%)of ONFH patients were detected by MRI and X-ray.The results of univariateχ^(2) test showed that there were statistically significant differences in the causes of fractures,Garden classification,time from injury to operation,arrangement of screws,whether the hollow nails was taken out or not and reduction quality between the two groups(P<0.05).The results of multivariate Logistic regression analysis showed that the Garden classification gradeⅢ~Ⅳ,the arrangement of screws is equilateral triangle,screw removal and reduction quality gradeⅢ~Ⅳwere the independent influencing factors for ONFH(P<0.05).The area under the curve(AUC)of the combined model of independent influencing factors was 0.809(95%CI:0.728~0.836).In the structural equation model,the path coefficients of the Garden classification,arrangement of screws,whether the hollow nails was taken out or not and reduction quality were 0.118,0.104,0.097 and 0.135 respectively(P<0.05),and the model determination coefficient was 0.28.Conclusion The Garden classification,arrangement of screws,whether the hollow nails is taken out or not and reduction quality are the independent influencing factors of ONFH after internal fixation in patients with femoral neck fractures,which can explain part of the OFNH variability,and combined the independent influencing factors model is more valuable for predicting ONFH.