PauwelsⅢ型股骨颈骨折患者发生创伤性骨坏死的影响因素分析

Factors influencing traumatic osteonecrosis in patients with Pauwels type Ⅲ femoral neck fracture

目的探讨PauwelsⅢ型股骨颈骨折(FNF)患者创伤性骨坏死发生的风险,并分析影响创伤性骨坏死发生的相关因素。方法选取温州医科大学附属第一医院2019年1月—2021年7月收治的257例FNF患者为研究对象,根据末次随访的影像学检查结果将所有患者分为坏死组和非坏死组。收集所有患者一般资料以及实验室检查结果,采用多因素logistic回归分析研究影响创伤性骨坏死发生的相关因素。结果截至末次随访,21例患者脱落,236例患者纳入研究,坏死组87例(36.86%),非坏死组149例(63.14%);2组损伤机制、复位方式以及复位质量组间比较差异均有统计学意义(P<0.05);坏死组载脂蛋白A1、Ⅰ型前胶原N-端前肽(PⅠNP)、一氧化氮(NO)水平以及基质细胞衍生因子-1(CXCL12)均低于非坏死组,载脂蛋白B以及IL-33水平均高于非坏死组(P<0.05);多因素logistic回归分析结果显示复位质量为C、高IL-33、高载脂蛋白B是创伤性骨坏死发生的危险因素,高CXCL12、高NO、高载脂蛋白A1是创伤性骨坏死发生的保护因素(P<0.05)。结论PauwelsⅢ型FNF创伤性骨坏死的发生率较高,且复位质量C、IL-33、CXCL12、NO、脂蛋白A1以及载脂蛋白B为FNF患者创伤性骨坏死发生的影响因素。

Objective To explore the risk of traumatic osteonecrosis in patients with Pauwels typeⅢfemoral neck frac-ture(FNF)and analyze associated factors.Methods A total of 257 cases of FNF from the First Affiliated Hospital of Wenzhou Medical University,treated from January 2019 to July 2021,were selected as the research object.According to the imaging findings of the last follow-up,all patients were divided into necrosis group and non-necrosis group.The gen-eral data and laboratory examination results of all patients were collected,and the factors affecting the development of traumatic osteonecrosis were analyzed by multivariate logistic regression.Results At the last follow-up,21 patients had fallen out and 236 patients were included in the study.There were 87 cases(36.86%)in the necrotic group and 149 ca-ses(63.14%)in the non-necrotic group.There were significant differences in injury mechanism,reduction mode,and reduction quality between the two groups(P<0.05).The levels of apolipoprotein A1,procollagenⅠN-terminal propep-tide(PⅠNP),nitric oxide(NO),and stromal cell-derived factor-1(CXCL12)in the necrotic group were lower than those in the non-necrotic group,while the levels of apolipoprotein B and IL-33 were higher(P<0.05).Multivariate lo-gistic regression analysis showed that the reduction quality of C,high IL-33 and high apolipoprotein B were risk factors for traumatic osteonecrosis,while high CXCL12,high NO and high apolipoprotein A1 were protective factors for traumatic osteonecrosis(P<0.05).Conclusion The incidence of Pauwels type III FNF traumatic osteonecrosis is higher.Reduc-tion quality C,IL-33,CXCL12,NO,lipoprotein A1,and apolipoprotein B were influencing factors of traumatic osteone-crosis in patients with femoral neck fracture.