股骨颈骨折内固定术患者89例术后随访分析

Follow up Analysis of 89 Cases of Neck of Femur Fracture after Internal Fixation

目的:探讨股骨颈骨折内固定术后并发股骨头缺血性坏死(ANFH)的相关危险因素,为临床治疗提供参考。方法:选取2019年5月至2021年1月因股骨颈骨折采取闭合复位加压空心螺钉内固定手术治疗且骨折愈合的89例患者进行回顾性研究;根据患者术后2年内是否发生股骨头缺血性坏死情况分为未坏死组和坏死组,收集两组患者的一般资料,包括年龄大小及分布情况、性别、体重指数、手术美国麻醉医师协会(ASA)分级、受伤能量、手术时间、骨折移位度(Garden分型)、骨折稳定度(Pauwels分型)、股骨头后倾角度、骨折复位质量;采用单因素方差分析对比两组患者相关因素的区别;结合多因素Logistic回归分析判定发生股骨头缺血性坏死的具体危险因素。结果:随访89例患者经X线及MRI影像学检查显示股骨头缺血性坏死22例,单因素分析结果显示受伤能量、手术时间、骨折移位度、股骨头后倾角度、骨折稳定度、骨折复位质量比较,差异有统计学意义(P<0.05),多因素Logistic回归分析结果显示骨折移位度为GardenⅢ~Ⅳ型、骨折稳定度为PauwelsⅢ型、股骨头后倾角>15°、骨折复位质量为Ⅲ~Ⅳ级为发生股骨头缺血性坏死相关影响因素,差异有统计学意义(P<0.01)。结论:骨折移位度为GardenⅢ~Ⅳ型、骨折稳定度为PauwelsⅢ型、股骨头后倾角>15°、骨折复位质量为Ⅲ~Ⅳ级,是股骨颈骨折内固定术后并发股骨头缺血性坏死的危险因素。

Objective:To explore the risk factors of avascular necrosis of the femoral head(ANFH)after internal fixation of femoral neck fracture,and to provide guidance for its clinical treatment.Methods:89 patients with femoral neck fracture who were treated with closed reduction and compression cannulated screw internal fixation from May 2019 to January 2021,and fracture healing were selected for a retrospective study.The patients were divided into non-necrotic group and necrotic group according to whether there was ANFH within 2 years after operation.The general data of patients in the two groups were collected,including age and distribution,gender,body mass index,surgical American society of anesthesiologists(ASA)grade,injury energy,fracture displacement(Garden classification),fracture stability(Pauwels classification),femoral head backward tilt angle,and fracture reduction quality.Univariate analysis of variance was used to compare the differences of related factors between the two groups.Combined with multivariate Logistic regression analysis,the specific risk factors of ANFH were determined.Results:In 89 patients,22 showed ANFH by X-ray and MRI imaging examination.The results of univariate analysis showed that there were statistically significant differences in injury energy,fracture displacement,femoral head tilt back angle,fracture stability,and fracture reduction quality(P<0.05).The results of multivariate Logistic regression analysis showed that fracture displacement(GardenⅢⅣtype),fracture stability(PauwellsⅢtype),femoral head retroversion angle>15°,and fracture reduction quality(ⅢⅣtype)were the relevant influencing factors for the occurrence of ANFH,and the difference was statistically significant(P<0.01).Conclusion:The degree of fracture displacement(GardenⅢⅣtype),fracture stability(PauwelsⅢtype),femoral head tilt back angle>15°,and fracture reduction quality(ⅢⅣ)are the risk factors of ANFH after internal fixation of femoral neck fracture.