股骨颈皮质碎片面积和移位距离与中青年股骨颈骨折空心螺钉内固定术后并发症的关系研究

Study on the relationship between area and displacement distance of femoral neck cortical fragments and complications resulting from hollow screw internal fixation in young and middle-aged patients with femoral neck fractures

目的:探讨股骨颈皮质碎片面积和移位距离与中青年股骨颈骨折空心螺钉内固定术后并发症的关系。方法:分析2009年1月至2021年1月采用空心螺钉内固定术治疗的合并股骨颈皮质粉碎的中青年股骨颈骨折患者的病例资料,统计患者股骨头坏死和骨折不愈合的发生情况,并基于术前CT测定患者的股骨颈皮质碎片面积和移位距离。股骨颈皮质碎片面积≤0.25cm^(2)、移位距离≤0.5cm者纳入A组,皮质碎片面积≤0.25cm^(2)、移位距离>0.5cm者纳入B组,皮质碎片面积>0.25cm^(2)、移位距离≤0.5cm者纳入C组,皮质碎片面积>0.25cm^(2)、移位距离>0.5cm者纳入D组。分析股骨颈皮质碎片面积和移位距离与股骨头坏死和骨折不愈合发生率的关系。结果:共纳入348例患者,A组160例、B组71例、C组82例、D组35例。34例患者发生股骨头坏死,其中A组6例、B组9例、C组9例、D组10例;25例患者发生骨折不愈合,A组3例、B组6例、C组7例、D组9例。A组股骨头坏死发生率为3.8%[95%CI(1.3%,8.0%)]、骨折不愈合发生率为1.9%[95%CI(0.4%,5.4%)],B组股骨头坏死发生率为12.7%[95%CI(6.0%,22.7%)]、骨折不愈合发生率为8.5%[95%CI(3.2%,17.5%)],C组股骨头坏死发生率为11.0%[95%CI(5.1%,19.8%)]、骨折不愈合发生率为8.5%[95%CI(3.5%,16.8%)],D组股骨头坏死发生率为28.6%[95%CI(14.6%,46.3%)]、骨折不愈合发生率为25.7%[95%CI(12.4%,43.3%)]。结论:中青年股骨颈骨折患者的股骨颈皮质碎片面积>0.25cm^(2)且移位距离>0.5cm时,采用空心螺钉内固定术治疗后股骨头坏死和骨折不愈合的发生率明显增高。

Objective:To explore the relationship between area and displacement distance of femoral neck cortical fragments and complications resulting from hollow screw internal fixation in young and middl-aged patients with femoral neck fractures(FNFs).Methods:The clinical data of young and middle-aged patients who underwent hollow screw internal fxation for treatment of FNFs combined with femoral neck cortical comminution from January 2009 to Januay 2021 were extracted and ana lyzed,followved by statistics on the incidence rates of femur head necrosis(FHN)and fracture nonunion.Furthermore,the area and displacement distance of femoral neck cortical fragments were measured on the CT films taken before the procedure.The patients with femoral neck cortical fragments having an area of≤0.25 cm(2)and displacement distance of≤0.5 cm were assigned into group A,the ones with femnoral neck cortical fragments having an ana of≤0.25 cm(2)and displacement distance of>0.5 cm into group B,the ones with femoral neck cortical fragments having an area of>0.25 cm(2)and displacement distance of≤0.5 cm into group C,and the ones with femoral neck cortical fragments having an arca of>0.25 cm(2)and dis-placement distance of>0.5 cm into group D.The relationship between the area and displacement distance of femoral neck cortical fragments and the incidence rates of FHN and fracture nonunion was analyzed.Results:TIhree hundred and forty-eight patients were included in the final analysis,160 patients in group A,71 onecs in goup B,82 ones in group C,and 35 ones in group D.Thirty-four patients experienced FHN,6 cases in groupA,9 cases in group B,9 cases in group C,and 10 cases in group D.Additionally,the fracture nounion was presented in 25 patients,3 cases in group A,6 cases in goup B,7 cases in group C,and 9 cases in group D.The incidence rates of FHN and fracture nonunion were 3.8%(95%C1(1.3%,8.0%))and 1.9%(95%C(0.4%,5.4%))in group A,12.7%(95%C1(6.0%,22.7%))and 8.5%(95%CI(3.2%,17.5%))in group B,11.0%(95%CI(5.1%,19.8%))and 8.5%(95%CI(3.5%,16.8%))in group C,28.6%(95%CI(14.6%,46.3%))and 25.7%(95%CI(12.4%,43.3%))in group D respectively.Conclusion:The incidence rates of FHN and fracture nonunion following hollow screw internal fixation will si gnificantly increase when the femoral neck cortical fragments have an area of>0.25 cm(2)and displacement distance of>0.5 cm in young and midde-aged patients with FNFs.