股骨颈骨折空心加压螺钉内固定后股骨头坏死分析  

Cannulated Compression Screws for the Treatment of Adult Femoral Neck Fractures Clinical Analysis of Risk Factors for Avascular Necrosis of the Femoral Head

作　　者：顾小明[1] 黄立新[2] 

机构地区：[1]靖江市人民医院骨科,江苏靖江214500 [2]苏州大学附属第一人民医院骨科,江苏苏州200072

出　　处：《实用骨科杂志》2014年第10期900-905,共6页Journal of Practical Orthopaedics

摘　　要：目的探讨成人股骨颈骨折空心加压螺钉内固定术后股骨头坏死的相关因素,为临床治疗决策提供参考。方法回顾分析2001年1月1日至2010年12月31日期间采用空心加压螺钉内固定手术患者,对年龄、性别、骨折类型（Garden分型）、手术复位质量（Garden指数）、受伤至手术时间间隔,复位方式（切开或闭合复位）、术后开始部分负重时间,内固定是否取出8个因素进行统计分析,筛选出差异有统计学意义的因素,然后对各单因素运用logistic多因素回归分析。结果其中有完整随访资料的185例,随访3～10年,平均5.5年,其中28例发生股骨头缺血坏死,坏死率15.14%,影响股骨头坏死的独立因素分别为：骨折类型,骨折复位质量,受伤至手术时间,术后开始部分负重的时间。结论空心加压螺钉治疗股骨颈骨折主要并发症是股骨头缺血性坏死,骨折类型、骨折复位质量、受伤至手术时间、术后开始部分负重的时间是发生股骨头坏死的主要危险因素。其中复位质量、受伤至手术时间、术后开始部分负重的时间是可控的因素,尽早手术复位骨折内固定,提高骨折复位质量,内固定3个月后开始部分负重均能降低股骨头缺血性坏死的发生。现有资料显示,空心加压螺钉内固定治疗股骨颈骨折的总体疗效满意,股骨头坏死率低,手术简单易行,技术要求低,创伤小,对于全身状况良好、预期寿命较长,骨质质量尚好的无移位或轻度移位的老年股骨颈骨折病例,以及年龄较轻的股骨颈骨折患者,建议首选内固定治疗。Objective To explore the related factors femoral head necrosis after the operation on adult femoral neck fractures by compressed hollow screws fixation.Methods The author reviewed the patients who were treated by compressed hollow screws fixation from January 1st,2001 to December 31 st,2010 and then made a statistical analysis on the following eight factors： age,gender,fracture type（ Garden type）,surgical reduction quality（ Garden index）,the time gap between injury and the operation,reset mode（ open reduction or close reduction）,the partial weight-bearing time after the operation,whether the fixation is removed.Among these eight factors,the statistically significant factors were selected and then analyzed by logistic regression analysis one by one.Results There are 185 cases with a complete set of follow-up data and the follow-up lasts from three to ten years（ the average duration is 5.5 years）.Among the 185 cases,28 patients suffered from femoral head ischemic necrosis,which accounts for 15.14% and the independent factors influencing femoral head necrosis included the following：fracture type,fracture reduction,the time gap between injury and the operation,the partial weight-bearing time after the operation.Conclusion The major complication of femoral neck fractures operation by compressed hollow screws fixation is femoral head ischemic necrosis and the major risk factors are fracture type,fracture reduction,the time gap between injury and the operation and the partial weight-bearing time after the operation.Among those factors,reduction quality,the time gap between injury and the operation and the partial weight-bearing time after the operation are controlling factors and it is found that femoral head ischemic necrosis can be lowered down when the patient receives compressed hollow screws fixation at an earlier time,improves reduction quality and tries to bear partial weight after three months＇ fixation.The present data shows that compressed hollow screws fixation is a satisfying treatment

关 键 词：股骨颈骨折 内固定 空心加压螺钉 股骨头坏死 

分 类 号：R683.42[医药卫生—骨科学]