股骨颈骨折行空心加压螺钉内固定后股骨头坏死相关因素研究  

The study of related factors on osteonecrosis of the femeral head caused by femoral neck fractures after the treatment of internal fixation with cannulated compression screws

作　　者：陈思圆 魏劲松 Chen Siyua;Wei Jinsong(Department of Orthopedics Center of the Affiliated Hospital of Guangdong Medical University,Zhanjiang 524000)

机构地区：[1]广东医科大学附属医院骨科中心,湛江524000

出　　处：《陕西医学杂志》2018年第9期1109-1112,共4页Shaanxi Medical Journal

基　　金：广东省医学科研基金资助项目(B2012277);广东医学院附属医院博士科研基金资助项目(BK201207)

摘　　要：目的:研究股骨颈骨折患者进行加压螺钉内固定手术后,发生股骨头坏死的主要原因。方法:通过36个月的随访,观察并比较140例股骨颈骨折并行空心加压螺钉内固定手术治疗患者的年龄、性别、骨折程度、骨折复位质量、牵引治疗、实施手术时机、完全负重时间以及取出内固定物的情况,进行单因素分析后选取具有统计学意义的相关因素再进行Logistic回归分析。结果:140例患者中出现股骨头缺血坏死者26例,发生率18.6%,发生股骨头坏死的时间为内固定手术后(24.3±12.8)月;患者的年龄、骨折复位质量、骨折程度(Garden分型)、是否取出内固定物、完全负重时间与股骨头坏死的发生具有关联性。结论:老年股骨颈骨折患者骨折程度较严重时,尽量选择行髋关节置换术,骨折复位质量需要通过X线透视进行客观评价,术后3个月内患者不能进行负重练习,若要取出内固定物,最好在手术24个月后进行。Objective:To explore the related factors on osteonecrosis of the femeral head caused by femoral neck fractures after the treatment of internal fixation with cannulated compression screws.Methods:By a 36 months follow-up,the age,gender,traction,the time of operation,garden type,surgical reduction quality,the weight-bearing time,whether the fixation was removed of the 140 patients who were treated by cannulated screws fixation were recorded.The single factor statistical analysis on the following factors was made and then the statistically significant factors were selected and analyzed by logistic regression analysis.Results:Two years later(24.3±12.8 months)after the sugery,26 cases in 140 patients occurred to be avascular necrosis(18.6%).The factors of age,fracture type,reduction quality,the weight-bearing time,whether the fixation wasremoved were related to the occurrence of osteonecrosis of the femeral head.Conclusion:The elderly patients with serious femoral neck fractures should select hip replacement.Surgical reduction quality should be estimated by X-ray.the weight bearing exercise should not to be done in 3 months after the operation.And the best time to remove the screws is 24 months after the operation.

关 键 词：股骨骨折/外科学 骨折切开复位 骨折固定术 内 股骨头坏死/预防和控制 

分 类 号：R683.4[医药卫生—骨科学]