Finite Element Analysis of Coronal Shear Fractures of the Femoral Neck: Displacement of the Femoral Head and Effect of Osteosynthetic Implants

Coronal shear fractures of the femoral neck (CSFF) are the most challenging to treat among proximal femur fractures, directly affecting the life expectancy of patients with osteoporosis. However, an adequate osteosynthesis method has not been elucidated yet. This study investigated the displacement direction of the femoral head fragment and its effect on the bone using finite element method. A finite element model for CSFF was developed from CT image data of a patient with osteoporosis using Mechanical Finder (ver. 11). Subsequently, finite element analyses were performed on six osteosynthesis models under maximum load applied during walking. The compressive stresses, tensile stresses, and compressive strains of each model were examined. The results suggested that the compressive and tensile stress distributions were concentrated on the anterior side of the femoral neck. Compressive strain distribution in the femoral head and neck was concentrated in four areas: at the tip of the blade or lag screw, the anteroinferior side of the blade or lag screw near the fracture site, and the upper right and lower left near the junction of the blade or lag screw and nail. Thus, the distribution of both these stresses revealed that the femoral head fragment was prone to anterior and inferior displacement. Distribution of compressive strains revealed the direction of the stress exerted by the osteosynthetic implant on the bone. The same results were observed in all osteosynthetic implants;thus, the findings could lay the foundation for developing methods for placing osteosynthetic implants less prone to displacement and the osteosynthetic implants themselves. In particular, the study provides insight into the optimal treatment of CSFF.

Spontaneous bilateral femur neck fracture secondary to grand mal seizure:A case report

BACKGROUND Spontaneous bilateral femur neck fracture is a rare entity in the general population.CASE SUMMARY A 17-year-old immobile,developmentally delayed male with the sequelae of cerebral palsy fractured both femoral necks during a grand mal epileptic seizure.He had been treated with valproic acid as an antiseizure medication for about 10years;otherwise,he had no history of drug use.The laboratory analysis was normal except a marked vitamin D deficiency.Closed reduction and osteosynthesis with percutaneous cannulated screws were performed.Solid union was observed at 6 mo,and rapid postoperative rehabilitation was started.CONCLUSION A femoral neck fracture may occur in a person with epilepsy presenting with hip pain in the emergency department.

Surgical Management of Fracture Neck of Femur in a Medically Unfit ASA3/4 Patient Selection Using Direct Infiltration Local Anaesthesia

Patients who suffer a Fractured Neck of Femur (NOF) have a high mortality and morbidity rate with up to 20% needing long term care post fracture and a further 30% not returning to their pre fracture functioning. Hip fracture accounts for 87% of total fragility fractures. We describe an anaesthetic technique of fixation of fracture of the femoral neck under direct infiltration local anaesthesia;that can be performed on the sick elderly patient. Twenty-eight NOF fractures were included in this series (24 DHS, 4 Hemiarthroplasty);twenty-three procedures were completed (82.14%);no patient required conversion to another form of anaesthesia either general or spinal;five patients required some degree of light sedation due to agitation (17.8%). This method presents itself as an option in managing patient with high comorbidities which can also be implemented in impoverished areas with limited access to operating surgical facilities.

Bone mineral density in fracture neck of femur patients:What's the significance?

BACKGROUND The National Institute for Health and Care Excellence(NICE)guidelines have advised further research is required into investigating the added prognostic value of bone mineral density(BMD)in the assessment of fracture risk with the Fracture Risk Assessment Tool(FRAX)score.AIM To investigate the significance of BMD in fracture neck of femur patients and compare it to the outcome of the FRAX score.METHODS Inclusion criteria for this study were all patients who underwent dual-energy Xray absorptiometry(DXA)scan following fracture neck of femur between 2015 and 2017.Analysis of BMD,FRAX scores and patient demographic data was undertaken.RESULTS A total of 69 patients were included in the study,mean age 74.1 years.There was no significant difference between mean BMD of the femoral neck in males(0.65)as compared to females(0.61)(P=0.364).Analyses showed no significant correlation between BMD and menopause age(rs=-0.28,P=0.090).A significant difference was seen of the femoral neck BMD between the different fracture pattern types(P=0.026).A stronger correlation was observed between BMD of femoral neck and FRAX major score(rs=-0.64,P<0.001)than with BMD of lumbar spine and FRAX major score(rs=-0.37,P=0.003).CONCLUSION This study demonstrated that BMD of the femoral neck measured by DXA scan is of added prognostic value when assessing patients for risk of fracture neck of femur in combination with the FRAX predictive scoring system.

Risk modeling of femoral neck fracture based on geometric parameters of the proximal epiphysis

BACKGROUND Fractures of the proximal femur epiphysis are problematic for state health care because they are associated with severe medical and social problems and high morbidity and mortality rates.AIM To model the potential risk of hip fracture via femur geometric parameters.METHODS Seventy educational cadaveric femurs from people aged 14 to 80 years,10 X-ray images from the records of the Human Anatomy Department and 10 X-ray images from the Department of Traumatology,Orthopedics and Disaster Surgery of Sechenov University,were evaluated.The parameters of the fractured bone were measured using images captured with a Canon d60 camera.The projection values of the proximal epiphysis of the cadaveric femurs and geometric parameters of the bones shown in the X-ray images were measured with Autodesk software(AutoCAD 2018).Analysis of the video frames showing bone rotation reveal that the greater trochanter can be inscribed in a parallelepiped,where one of the faces is parallel to the plane of view in the frontal standard projection and is rectangular.The angle of bone rotation obtained by turning the cube corresponded to the angle measured with the second technique.This reliable method of calculating the rotation of the bone relative to the anterior projection was employed in subsequent calculations.The geometric parameters of the femur were measured using X-ray images according to the proposed method.RESULTS The geometric parameters of 70 femurs were analyzed,and correlation coefficients were calculated.Our measurement results were compared with those reported by other authors.The potential influence of femur geometry on force distribution in the proximal epiphysis of the femur was described,and a 2-dimensional model of the femur epiphysis associated with minimal neck fracture risk was provided.The assessment of the geometric parameters of the femoral epiphysis indicated the greatest risk of a varus fracture of the neck if the angle of the minimal resistance zone(AMRZ)index>24°and the neck-shaft angle(NSA)<127.5°.In contrast,the minimum risk was observed at AMRZ<14°and NSA>128.87°.CONCLUSION The proposed method provides the potential femur neck fracture risk based on geometric parameters.

Thirty-day mortality of patients with hip fracture during COVID-19 pandemic and pre-pandemic periods:A systematic review and metaanalysis

BACKGROUND Timely intervention in hip fracture is essential to decrease the risks of perioperative morbidity and mortality.However,limitations of the resources,risk of disease transmission and redirection of medical attention to a more severe infective health problem during coronavirus disease 2019(COVID-19)pandemic period have affected the quality of care even in a surgical emergency.AIM To compare the 30-d mortality rate and complications of hip fracture patients treated during COVID-19 pandemic and pre-pandemic times.METHODS The search of electronic databases on 1st August 2020 revealed 45 studies related to mortality of hip fracture during the COVID-19 pandemic and pre-pandemic times.After careful screening,eight studies were eligible for quantitative and qualitative analysis of data.RESULTS The pooled data of eight studies(n=1586)revealed no significant difference in 30-d mortality rate between the hip fracture patients treated during the pandemic and pre-pandemic periods[9.63%vs 6.33%;odds ratio(OR),0.62;95%CI,0.33,1.17;P=0.14].Even the 30-d mortality rate was not different between COVID-19 non-infected patients who were treated during the pandemic time,and all hip fracture patients treated during the pre-pandemic period(OR,1.03;95%CI,0.61,1.75;P=0.91).A significant difference in mortality rate was observed between COVID-19 positive and COVID-19 negative patients(OR,6.99;95%CI,3.45,14.16;P<0.00001).There was no difference in the duration of hospital stay(OR,-1.52,95%CI,-3.85,0.81;P=0.20),overall complications(OR,1.62;P=0.15)and incidence of pulmonary complications(OR,1.46;P=0.38)in these two-time frames.Nevertheless,the preoperative morbidity was more severe,and there was less use of general anesthesia during the pandemic time.CONCLUSION There was no difference in 30-d mortality rate between hip fracture patients treated during the pandemic and pre-pandemic periods.However,the mortality risk was higher in COVID-19 positive patients compared to COVID-19 negative patients.There was no difference in time to surgery,complications and hospitalization time between these two time periods.

股骨颈骨折空心钉内固定后股骨近端骨质疏松的有限元分析

背景:股骨颈骨折空心钉内固定术后由于患肢短期内常常不能负重,且高刚度的内植物对骨折断端存在应力遮挡效应,易导致患肢出现骨质疏松,股骨近端生物力学分布发生变化,术后股骨头坏死发病率较高,目前关于股骨颈骨折术后股骨近端骨质疏松对股骨近端及空心钉生物力学影响的研究较少。目的:通过有限元分析探讨股骨颈骨折术后发生骨质疏松对空心钉内固定治疗的生物力学影响,探究生物力学因素在股骨头坏死进程中的作用。方法:获取1例股骨颈骨折患者股骨CT扫描数据,利用Mimics 19.0、3-Matic、UG 11.0、Hypermesh 14.0、Abaqus软件建立空心钉治疗股骨颈骨折的股骨近端模型,利用Abaqus软件分析1种术后股骨近端无骨质疏松、3种术后股骨近端骨质疏松的有限元模型,测量分析4种模型不同部件的应力、接触压力、位移峰值及云图,对比分析股骨头内部应力变化及分布情况。结果与结论:股骨头及下前空心钉的应力、接触压力随骨质疏松程度变化较大,4种模型的位移峰值随着骨质疏松程度加重而缓慢增长。通过单因素方差分析,结果显示骨质疏松程度对不同部件的应力、接触压力、位移峰值无显著性影响,股骨头内部应力分布随骨质疏松发生相应变化,股骨近端的生物力学环境变化对股骨头坏死有着重要影响。

ERAS理念联合骨科康复护理对股骨颈骨折患者髋关节置换术后疼痛及恢复情况的影响

目的探究加速康复外科(ERAS)理念联合骨科康复护理对股骨颈骨折患者髋关节置换术后疼痛及恢复情况的影响。方法选取安徽省马鞍山市中医院2019年1月至2022年3月进行治疗的股骨颈骨折患者80例,采用随机数字表法将其分为对照组和观察组,各40例。对照组给予骨科常规康复护理,观察组给予骨科常规康复护理联合ERAS理念进行干预。干预前后比较两组术后恢复情况,包括髋关节功能、髋关节置换效果、视觉模拟评分法(VAS)评分、术后情况、术后并发症发生情况。结果干预后,观察组各项髋关节功能评分均高于对照组,差异有统计学意义(P<0.05)。干预后,两组各项髋关节置换效果评分高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05);两组VAS评分低于干预前,且观察组低于对照组,差异有统计学意义(P<0.05)。干预后,观察组住院天数、术后下床活动时间短于对照组,差异有统计学意义(P<0.05);观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论ERAS理念联合骨科康复护理能够缩短股骨颈骨折患者的术后住院时间和下床所需时间,缓解术后疼痛,减少并发症,促进术后髋关节恢复。

不同构型内固定螺钉对治疗股骨颈骨折影响的有限元分析

通过有限元分析方法,探讨在Pauwels II型股骨颈骨折中应用传统实心螺钉及低刚度空心螺钉的生物力学差异,为低刚度空心螺钉的临床应用提供参考。基于1例老年男性股骨颈骨折志愿者的股骨二维CT影像数据,利用Mimics软件进行股骨三维模型重建,采用Geomagic软件对模型进行平滑降噪处理,随后采用Solidworks软件建立2种内固定螺钉的三维模型,与股骨骨折模型进行装配。最后,采用Abaqus软件按照单足站立状态下的实际生物力学状态设置载荷及边界条件,完成有限元模型的建立及分析。研究结果表明:采用空心螺钉和实心螺钉的内固定模型上各螺钉应力峰值的标准差分别为12.71 MPa和85.34 MPa,股骨远端应力峰值分别为78.72 MPa和79.64 MPa,股骨整体位移峰值分别为2.020 mm和2.086 mm,骨折面应力峰值分别为216.4 MPa和210.2 MPa;空心螺钉可使多螺钉间应力分配更加均匀,提高螺钉承载能力及疲劳寿命;空心螺钉组股骨具有更小的应力及位移,表明其具有更强的稳定性;采用空心螺钉组时,骨折面附近应力小幅度提高,对骨折愈合起到促进作用。

Comparison of Proximal Femoral Geometry and Risk Factors between Femoral Neck Fractures and Femoral Intertrochanteric Fractures in an Elderly Chinese Population

Background： Few studies have investigated the differences in proximal femoral geometry and risk factors between patients with different types of hip fracture, especially in elderly Chinese. This study aimed to assess the differences in proximal femoral geometry parameters between patients with femoral neck fractures and patients with intertrochanteric fractures to provide guidance for individualized customized prosthesis and accurate reconstruction of proximal femurs in elderly Chinese patients. Methods： We retrospectively studied the electronic medical records of 198 elderly patients over 65 years of age who were admitted to the orthopedic department with hip fractures between January 2017 and December 2017 in The Third Hospital, Hebei Medical University. Age, fracture site, gender, and proximal femoral geometry parameters （.neck shaft angle [NSA], center edge angle [CEA], femoral head diameter [FHD], femoral neck diameter [FND], femoral neck axial length [FNAL], hip axial length [HAL], and femoral shaft diameter [FSD]） were recorded. Student＇s t-test was used to compare the continuous variables, Chi-square test was used to analyze categorical variables, and multiple logistic stepwise regression analysis was used to evaluate the influencing factors of hip fracture type. Results： Statistically significant differences in NSA （137.63 ± 4.56° vs. 132.07 ± 4.17°, t = 1.598, P 〈 0.001）, CEA （37.62 ± 6.77° vs. 43.11 ±7.09°, t = 5.597, P 〈 0.001 ）, FND （35.21 ± 3.25 mm vs. 34.09 ±3.82 mm, t = 2.233, P = 0.027）, and FNAL （99.30 ± 7.91 mm vs. 103.58± 8.39 ram, t = 3.715, P 〈 0.001 ） were found between the femoral neck fracture group and femoral intertrochanteric fracture group. FHD, FND, FSD, HAL, and FNAL were different between sexes （all P 〈 0.001 ）. The greater NSA was the risk factor for femoral neck fractures （,odds ratio [OR]： 0.70, P 〈 0.001 ）, greater CEA and longer FNAL were risk factors for femoral intertrochanteric fractures （OR： 1.15, 1.17, all P 〈 0.001）, and greater FND was a protective factor for femoral intertrochanteric fractures （OR： 0.74, P 〈 0.001）. Conclusions： We demonstrate differences in geometric morphological parameters of the proximal femur in different hip fracture types, as well as an effect of sex. These differences should he considered in the selection of prostheses for fracture internal fixation and hip replacements. These data could help guide the design of individualized customized prostheses and improve the accurate reconstruction of the proximal femur for elderly Chinese hip fracture patients.

中药“人参养荣汤”结合人工关节置换治疗股骨颈骨折内固定失败疗效观察

目的:观察人工髋关节置换结合口服中药治疗股骨颈骨折内固定失败患者的临床疗效。方法:选择2020年5月至2023年5月25例股骨颈骨折内固定失败的患者,这些患者均通过口服中药结合人工髋关节置换来进行治疗的,根据中医理论-骨折三期辨证为基础,骨折长时间不愈合,病程较长,则会耗气伤津,肝肾功能受损,治法上选择调补肝肾、充养气血,采用人参养荣汤加减口服。其中男13例,女12例;年龄42~85岁,平均63.7岁;左髋病例数共12例,右髋病例数共13例。这些患者在平均25.1个月(2个月~2年)间隔时间内行了两次手术。结果:本组纳入病例为25例,其中采用生物杯直接固定为17例,先对病例进行植骨修复缺损再采用生物杯固定的有7例,有1例先行植骨修复缺损钛网杯固定再使用骨水泥臼杯固定的,其中有12例患者采用了股骨柄生物型柄,有13例则采用了骨水泥柄。无术中并发症发生,手术平均时间120 min,出血量平均550 mL,输血量平均500 mL,平均术中补液量2400 mL,术后早期脱位1例。术后6~25个月(平均15.1个月)为本次入组患者的随访时间,本组病例术后情况良好,所有术后切口均无红肿渗液,所植入假体均无下陷、松动的表现,未超过远端螺钉孔的假体长度,此类患者也无二次发生应力骨折,Harris评分平均89.3分(术前39.8分)。结论:中药“人参养荣汤”结合人工关节置换治疗股骨颈骨折内固定失败患者,可使患者在术后早期下地活动锻炼,缩短卧床时间,能更好地预防卧床并发症,对患者近期的康复有良好的临床效果,而对于远期疗效,则需要进一步临床验证。

全程闭环体温管理对股骨颈骨折患者围手术期的干预效果分析

目的:探讨全程闭环体温管理对股骨颈骨折患者围手术期的干预效果分析。方法:选择2020年6月-2022年5月天津医院收治的91例股骨颈骨折患者为研究对象,按照计算机分组法分为对照组(n=45)和观察组(n=46)。对照组采用常规体温监测管理,观察组采用全程闭环体温管理。观察2组术中失血量、术后恢复情况、不同时间核心体温变化、凝血指标水平及围手术期不良反应发生率。结果:观察组术中失血量均低于对照组,差异有统计学意义(P<0.05)。观察组清醒、拔管所需、麻醉恢复室(PACU)滞留时间均短于对照组,组间差异有统计学意义(P<0.05)。切皮时、手术结束时,2组体温均降低,但观察组高于对照组,差异有统计学意义(P<0.05);出PACU时,观察组体温高于对照组,差异有统计学意义(P<0.05)。术后,2组凝血酶时间、凝血酶原时间及活化部分凝血活酶时间均降低,但观察组比对照组高,差异有统计学意义(P<0.05)。观察组低体温、寒颤、躁动发生率低于对照组,差异有统计学意义(P<0.05)。结论:对股骨颈骨折患者实施全程闭环体温管理,有利于维持核心体温,改善凝血功能,减少术中失血量,从而降低术后低体温、寒颤、躁动发生率,促进术后恢复。

空心加压螺钉治疗股骨颈骨折疗效分析

目的:探讨空心加压螺钉内固定术治疗股骨颈骨折的疗效及术后致股骨头缺血性坏死的相关影响因素。方法:对2003年1月至2009年6月应用空心加压螺钉治疗的96例股骨颈骨折进行回顾性分析,男44例,女52例;年龄21～88岁,平均56.3岁。将患者年龄、性别、骨折类型、骨折复位情况、外伤至手术复位时间与术后骨折不愈合及股骨头缺血性坏死之间的关系进行统计学分析。结果:84例获得随访,时间9～60个月,平均25.4个月。术后出现下肢深静脉血栓2例,骨折不愈合8例,股骨头缺血性坏死11例。术后Harris评分为(86.20±11.00)分,优40例,良32例,可7例,差5例。未移位骨折组和移位骨折组股骨头坏死发生率分别为3.22%和18.87%,两者差异有统计学意义(P=0.037);解剖复位组和非解剖复位组的股骨头坏死发生率分别为5.00%和20.45%,两者差异有统计学意义(P=0.036);而不同年龄、性别、手术时间对继发股骨头坏死无明显差异。结论:空心加压螺钉内固定术治疗无移位股骨颈骨折疗效良好,骨折类型及骨折复位情况是影响术后股骨头缺血性坏死的主要因素。对年轻移位的股骨颈骨折患者,应尽可能解剖复位、牢靠内固定,以减少术后股骨头缺血性坏死的发生;对于骨折移位严重的高龄患者,建议行人工关节置换术。

股骨颈骨折内固定术后致股骨头坏死的影响因素分析

目的:探讨股骨颈骨折患者内固定术后致股骨头坏死的相关影响因素。方法:对上海市第六人民医院1999年5月至2004年4月期间收治的患者,进行术后门诊随访和通讯手段随访相结合的形式获得有完整随访资料者99例,运用SPSS14.0建立数据库,并进行统计分析。结果:到2006年1月为止,99例患者术后随访共有15例出现坏死,坏死率为15.2%。交互作用分析得出:年龄与内固定是否取出、性别与复位时间存在交互作用;单因素Logistic回归分析得出:年龄、骨折是否移位、复位质量和内固定是否取出是影响因素;多因素Logistic逐步回归分析得出:年龄、年龄与内固定是否取出、复位质量是股骨头坏死的相关影响因素;多因素Logistic逐步回归后的精细分析得出:56～85岁患者中,内固定取出组股骨头坏死是未取出组的26.00倍(95%CI=3.076～219.747)。结论:股骨颈骨折患者内固定术手术时年龄越大,越不易并发股骨头坏死;对于老年患者,取出内固定可能会增加股骨头坏死和塌陷的风险;解剖复位有助于降低内固定术后股骨头坏死的发生率。

股骨颈骨折修复后股骨头坏死7个相关因素:199例回顾分析

背景:股骨颈骨折内固定后发生股骨头坏死率较高,其危险因素一直没有明确的专家共识。目的:回顾性提出和分析60岁以下股骨颈骨折内固定后发生股骨头坏死的相关危险因素。方法:对199例60岁以下股骨颈骨折行闭合复位空心钉内固定的病例进行回顾性分析。对年龄,性别,体质量指数,Garden分型,骨折季节,骨折复位质量,内固定后完全负重下床时间7个因素进行统计分析,评估这些因素与股骨头坏死之间的关系。结果与结论:(1)199例股骨颈骨折患者内固定后股骨头坏死发生率13%;(2)体质量指数,Garden分型,骨折季节季节性变动及骨折复位质量与内固定后股骨头坏死密切相关。患者年龄、性别,内固定后负重时间与内固定后股骨头坏死无明显相关性;(3)Logistic回归多因素分析,Garden分型、骨折复位质量和骨折季节性变动(冬季vs夏季)对于股骨颈骨折后股骨头坏死的发展有明显影响;(4)结果提示,股骨颈骨折的Garden分型及骨折复位质量对股骨颈骨折术后愈合有很大的影响;冬季骨折可能是股骨颈骨折内固定后发生股骨头坏死的危险因素。

全髋关节置换与人工股骨头置换修复老年股骨颈骨折:18个月随访比较

背景:老年股骨颈骨折患者行人工髋关节置换治疗,关于选择全髋关节置换还是人工股骨头置换目前仍存在争议。目的:比较人工股骨头置换与全髋关节置换修复老年人股骨颈骨折后18个月的随访结果。方法:纳入行人工髋关节置换的股骨颈骨折患者70例,男17例,女53例,年龄60-83岁,均为GardenⅢ型,Ⅳ型患者。根据置换方式分为两组,股骨头置换组39例,全髋关节置换组31例,两组患者性别、年龄、骨折分型及合并疾病构成上差异无显著性意义,具有可比性。X射线观察两组患者关节置换效果,综合比较两组患者术中输血量、术中失血量、术后引流量、手术时间、住院时间及置换后髋关节功能。结果与结论:经18个月随访,两组患者X射线显示股骨颈骨折均复位固定良好,假体位置良好。两组患者住院时间和术后引流量比较差异无显著性意义(P>0.05);两组患者术中输血量、失血量及手术时间比较,股骨头置换组优于全髋关节置换组(P<0.05);全髋关节置换组的髋关节功能恢复优良率显著高于股骨头置换组(P<0.05)。提示老年股骨颈骨折行全髋关节置换后关节功能恢复较好,远期并发症较低,是老年人股骨颈骨折的首选治疗方法;人工股骨头置换具有手术时间短、出血少及输血量少等优点,适合身体状况差、活动量小及受伤前患肢已有功能障碍的高龄患者。

精确定位防旋髓内钉置入治疗股骨转子间骨折

背景:闭合复位股骨近端防旋髓内钉内固定渐渐成为治疗股骨转子间骨折的金标准。目的:通过与标准切口对比,评价精确定位法改良小切口使用股骨近端防旋髓内钉置入治疗股骨转子间骨折的优势。方法:股骨转子间骨折接受闭合复位股骨近端防旋髓内钉置入内固定治疗的患者99例,其中采用改良后小切口方法的患者41例,采用标准切口的58例。对比两组患者的切口长度、内固定中出血量、平均住院时间及内固定后Harris评分。结果与结论:采用改良切口组患者内固定中出血量较标准切口组少50.9%,切口长度短44%,平均置入内固定时间明显短于标准切口组(P<0.05),两组患者平均住院时间及随访末期Harris评分值差异无显著性意义。说明使用股骨近端防旋髓内钉治疗股骨转子间骨折的病例,采用改良小切口具有切口更小,创伤更小,操作时间短及出血量少的优点。

股骨颈骨折内固定术后股骨头坏死的相关因素分析及生活质量评价

目的:探讨年轻患者股骨颈骨折内固定术后发生股骨头坏死的危险因素,描述股骨头存活患者的生活质量,量化其预测因素。方法:选取2013年1月至2016年12月采用闭合复位空心钉内固定手术治疗的股骨颈骨折患者172例(174髋)进行回顾性分析,总结患者的一般资料包括年龄、性别、体重指数、创伤机制、创伤-手术间隔时间、创伤发生季节和内固定物是否取出,影像学资料包括骨折Garden分型、Pauwel分型、股骨头后倾角度、术后骨折复位、螺钉分布情况。进行单因素分析及多因素Logistic回归分析,探讨股骨头坏死及内固定失败的危险因素。对上述内固定术后股骨头存活的患者进行随访,通过SF-36健康调查简表评估患者的生活质量,髋关节功能Harris评分评估患髋关节功能,并通过多重线性回归分析探讨股骨颈骨折术后患者生活质量的预测因素。结果:172例(174髋)患者纳入研究,共29例(16.67%)患者发生股骨头坏死。股骨头坏死多因素Logistic回归分析中有显著差异的变量是复位质量(OR=0.126,P=0.027)和后倾角(OR=4.380,P=0.010)。股骨头存活136例患者(137髋)纳入生活质量调查,Harris评分90.14±7.92,其中优96髋(70.07%),良28髋(20.44%),中13髋(9.49%),差0髋。SF-36评分中生理健康得分为46.12±9.12,心理健康得分为50.21±3.97,两者不呈线性相关(P>0.05),多重线性回归分析中,与生理健康得分相关有显著差异的变量是复位质量与后倾角度,与心理健康得分相关有显著差异的变量是骨折是否移位与创伤机制。结论:复位质量位不佳和后倾角>15°是并发股骨头坏死的危险因素。股骨颈骨折术后患者髋关节功能及心理健康得分恢复良好,但生理健康得分不能恢复到正常人群平均水平,复位质量与后倾角度可作为生理健康得分预测因素,骨折是否移位与创伤机制可作为心理健康得分的预测因素。

55岁以下成年移位股骨颈骨折内固定术后失败的研究分析

目的:回顾性研究年龄55岁以下成年患者移位股骨颈骨折内固定治疗失败病例以提高对其治疗的重视。方法:2007年1月至2010年6月治疗55岁以下移位股骨颈骨折内固定术后失败患者18例,男13例,女5例;年龄27～55岁,平均(48.0±6.0)岁;空心钉治疗17例,髓内钉治疗1例。入院时诊断为股骨头坏死16例,骨不连合并股骨头坏死2例。结果:18例患者内固定术后至手术失败时间8～32个月,平均23个月。复位内固定术后Garden指数不佳;入院时髋关节Harris评分33～80分,平均(56.0±12.5)分。8例股骨头坏死病例和2例骨不连合并股骨头坏死病例接受了全髋关节置换术,5例股骨头坏死病例接受了表面髋关节置换术,3例虽然影像学有股骨头坏死征象但临床症状不明显,接受了保守治疗。所有行髋关节表面置换和全髋关节置换的病例术后随访12～53个月,平均34个月,术后Harris评分(94.0±3.0)分(89～96分)。结论:股骨头坏死是55岁以下成年移位股骨颈骨折闭合复位内固定术后常见并发症,必须提高对青壮年股骨颈骨折闭合复位内固定治疗的重视。

鲑鱼降钙素对老年股骨颈骨折患者骨代谢的影响

目的探讨皮下注射鲑鱼降钙素对老年骨质疏松股骨颈骨折患者短期血液骨代谢生化指标的影响,为其提高疗效提供依据。方法选取120例股骨颈骨折患者,随机分为实验组(n=60):皮下注射鲑鱼降钙素治疗组,对照组(n=60):皮下注射生理盐水空白对照组,比较两组患者手术前,手术后1、3、7d血清钙、磷浓度和碱性磷酸酶(ALP)活性的变化情况。结果血液生化指标检查可见术后3、7d,实验组患者血清总钙、磷浓度及ALP活性均发生变化,其中实验组患者血清钙下降明显(P<0.05,P<0.01),且超出正常范围。血清磷术后7d显著低于对照组。ALP两组比较及术前、术后比较均差异不显著。结论短期应用皮下注射鲑鱼降钙素可对血清骨代谢标记物产生显著影响,其中血清钙受影响最大,血清总钙水平显著低于正常生理范围,临床应用过程中应引起重视并给予预防。