股骨颈骨折空心钉内固定术后股骨颈短缩的危险因素分析

Analysis of risk factors of femoral neck shortening after fixation of femoral neck fractures with cannulated screws

目的分析空心钉内固定术治疗股骨颈骨折术后股骨颈短缩的危险因素。方法回顾性分析自2015-01—2022-01采用空心钉内固定治疗的103例股骨颈骨折,其中55例采用3枚空心钉倒三角形内固定,48例采用4枚空心钉菱形固定。根据术后有无发生股骨颈短缩分为短缩组和非短缩组,比较两组年龄、性别、骨密度、骨折Garden分型、解剖分型、骨折至手术时间、手术时间、螺钉数量、术后负重时间、复位质量,将差异有统计学意义的因素纳入多因素Logistic回归分析。结果所有患者均获得随访,随访时间15~26个月,平均19.87个月。根据术后有无发生股骨颈短缩分为短缩组(n=51)和非短缩组(n=52),两组年龄、性别、骨折Garden分型、解剖分型、骨折至手术时间、手术时间差异无统计学意义(P>0.05),两组骨密度值、螺钉数量、负重时间、复位质量差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示负重时间<8周、骨密度降低(T值≤-2.5 SD)、螺钉数量为3枚、复位质量为Garden指数Ⅱ级是股骨颈骨折内固定术后发生颈短缩的独立危险因素(P<0.05)。结论采用4枚空心钉菱形固定、良好的复位质量及推迟负重时间可以减少股骨颈骨折术后股骨颈短缩的发生,更好地改善髋关节功能。

Objective To analyze the incidence and risk factors of femoral neck shortening after fixation of femoral neck fractures with cannulated screws.Methods From January 2015 to January 2022,103 patients with femoral neck fractures who were treated with closed reduction and cannulated screw internal fixation and had complete follow-up information were retrospectively analyzed.Among them,55 cases were treated with 3 cannulated screw internal fixation and 48 cases were treated with4 cannulated screw internal fixation.According to whether or not femoral neck shortening occurred after operation,the patients were divided into short shortening group and non-short shortening group.Using chi-square analysis of single factor,age,gender,bone mineral density,fracture type,anatomical type,injury to the operation time,operation time,screw number,weightbearing time and reset quality,factors with statistically significant differences were included in multivariate Logistic regression analysis.Results Patients were followed up for 15-26 months,with an average of 19.87 months,and the follow-up rate was100%.According to whether femoral neck shortening occurred after operation,the patients were divided into short shortening group(n=51)and non-short shortening group(n=52).Univariate and multivariate Logistic regression analysis showed that decrease in bone mineral density(T value≤-2.5),the number of cannulated screws(3 screws),weight-bearing time(<8 weeks)and reduction quality(reduction of garden indexⅡ)were independent risk factors for neck shortening after internal fixation of femoral neck fracture(P<0.05).There was no significant difference between the two groups in age,sex,time from injury to operation,operation time and fracture classification(P>0.05).Conclusion Using four cannulated screw fixation,good reduction and postponement of weight-bearing time can reduce the incidence of femoral neck shortening after femoral neck fracture in patients,and better improve hip function.