股骨颈骨折闭合复位加压螺纹钉内固定术后股骨头坏死多中心多因素相关分析  

A multiple correlation factors analysis of avascular necrosis after closed reduction and cannulated compression screws fixation of intra-capsular femoral neck fracture. A multi-center retrospectivestudy

作　　者：周锦春[1] 郭敦明[1] 王青[1] 陈哲峰[1] 崔维顶[1] 范卫民[1] 刘锋[1] 

机构地区：[1]南京医科大学第一附属医院骨科,210029

出　　处：《中华骨科杂志》2013年第5期549-554,共6页Chinese Journal of Orthopaedics

摘　　要：目的调查股骨颈骨折闭合复位加压螺纹钉内固定术后股骨头坏死的发生率，探讨各影响闪素与股骨头坏死的相关性。方法对江苏地区2001至2010年期间接受闭合复位加压螺纹钉内固定治疗的股骨颈骨折患者进行回顾性调查。以股骨头坏死作为观察指标，将患者的年龄、性别、伤侧、损伤机制、骨折类型（移位程度）、手术前时间间隔、骨折复位质量、术后患肢不负重时间、内固定排列方式以及内固定是否取出作为相关影响因素，运用logistic回归进行多因素分析。结果共随访获得1849例患者的完整资料，平均随访时间（6．5±2．7）年。共有246例患者发生股骨头坏死，股骨头坏死发生率为13.3％。发生股骨头坏死的时间平均为伤后（17．0±4．6）个月（8－72个月）。未发生股骨头坏死的1603例患者调查时髋关节Harrs评分平均为（93．8±8．9）分（78-100分）。多冈素回归分析显示骨折移位程度、骨折复位质量与股骨头坏死有相关性（OR=2．078，3．423）。结论闭合复位加压螺纹钉内固定治疗股骨颈骨折町以取得满意的效果，股骨头坏死的发生与骨折移位程度及骨折复位质量明显相关。Objective To determine the incidence of avascular necrosis after closed reduction andcannulated compression screws fixation of intra-capsular femoral neck fracture and to investigate the multiple factors correlated to avascular femoral head necrosis. Methods All the patients of intra-capsular femoral neck fracture who accepted closed reduction and cannulated compression screws fixation between 2001 and 2010 in Jiangsu Province were reviewed in muhi-centers retrospectively. The multiple factors were analyzed including age, gender, affected side, mechanism of injury＇, fracture classification, procedure delay, quality of reduction, time of full-weight-bearing, configuration of the screws and removal of the screws. Multiple correlation factors were analyzed with SPSS 13.0 statistic system. Results Complete ease records were documented in 1849 cases who were followed up for an average 6.5±2.7 years （range, 2-10 years）. Avascular necrosis occurred in 246 cases （13.3%）. The average time of diagnosis of avascular necrosis was 17±4.6 months （range, 8-72 months） after injury. The average Harris score of the hips which didn＇t develop to avascular necrosis was 93.8±8.9 （range, 78-100） at the last follow up. Multiple correlation factors analysis indicated that displacement degrees of fracture and the quality of reduction were significantly correlated to the incidence of avascular necrosis （OR=2.078,3.423）. Conclusion Closed reduction and cannulated compression screws fixation after the intra-capsular femoral neck fracture can get satisfactory results. Displacemerit degrees of fracture and the quality of reduction are significantly correlated to the incidence of avascular femoral head necrosis.

关 键 词：股骨颈骨折 股骨头坏死 LOGISTIC模型 多中心研究 

分 类 号：R687.3[医药卫生—骨科学]