成人股骨颈骨折术后股骨头坏死的多因素分析

Multivariate analysis of osteonecrosis of femoral head after operation for femoral neck fracture in adults

目的 探讨成人患者股骨颈骨折术后发生股骨头坏死(ONFH)的相关危险因素。方法 回顾性分析2018年1月至2021年7月我院收治的150例股骨颈骨折患者的临床资料。根据患者是否出现ONFH分为坏死组和存活组。收集并比较2组患者性别、年龄、BMI、受伤后至手术时间、Garden分型、内固定是否取出、内固定取出时间、股骨头后倾角度、术后骨折复位质量等临床资料,并行单因素及非条件二分类Logistic回归分析。结果 150例成人股骨颈骨折患者中,41例出现术后ONFH(27.33%)。单因素分析结果显示,BMI、受伤后至手术时间、Garden分型、股骨头后倾角度、内固定取出时间以及术后骨折复位质量与ONFH的发生密切相关(P<0.05)。多因素Logistic回归分析结果显示,BMI≥25 kg/m^(2),Garden分型为Ⅲ、Ⅳ型,术后骨折复位质量为B、C级,内固定取出时间<2年是成人股骨颈骨折术后ONFH发生的独立危险因素。结论 成人股骨颈骨折术后ONFH的发生率较高。BMI、Garden分型、术后骨折复位质量、内固定取出时间均会影响股骨颈骨折术后ONFH的发生。临床应针对相关影响因素加强干预,以降低ONFH的发生率,提高患者生活质量。

Objective To investigate the related risk factors of osteonecrosis of femoral head(ONFH)after operation for femoral neck fracture in adult patients.Methods The clinical data of 150 patients with femoral neck fracture admitted to our hospital from January 2018 and July 2021 were retrospectively selected.The patients were divided into the necrosis group and the survival group based on whether ONFH occurred or not.The clinical data including gender,age,BMI,time from injury to operation,Garden's classification,whether internal fixation was removed or not,timing of internal fixation removal,posterior tilt angle of femoral head,and quality of postoperative fracture reduction of patients in the two groups were collected and compared.Univariate and unconditional binary Logistic regression analysis were conducted.Results Among 150 cases of adult femoral neck fracture patients,41 cases developed ONFH(27.33%)after operation.Univariate analysis revealed that BMI,time from injury to operation,Garden's classification,posterior tilt angle of femoral head,timing of internal fixation removal,and quality of postoperative fracture reduction were closely related to the occurrence of ONFH(P<0.05).Multivariate Logistic analysis showed that BMI≥25 kg/m^(2),typeⅢorⅣof Garden's classification,quality of postoperative fracture reduction grade B or C,and timing of internal fixation removal<2 years were the independent risk factors for ONFH after operation for femoral neck fracture in adults.Conclusion The incidence of ONFH after operation for femoral neck fracture in adults is high.BMI,Garden's classification,quality of postoperative fracture reduction,and timing of internal fixation removal can all affect the occurrence of ONFH after operation for femoral neck fracture.Clinical interventions targeting these related factors should be strengthened to reduce the incidence of ONFH and improve patients'quality of life.