顺行髓内钉治疗股骨干骨折后发生股骨头坏死的原因分析  

Analysis of the pathogenesis of femoral head osteonecrosis after intramedullary nailing treatment of femoral shaft fractures

作　　者：杨雨润[1] 李子荣[1] 孙伟[1] 陈瀛[1] 林朋[1] 刘成刚[1] YANG Yurun;LI Zirong;SUN Wei;CHEN Ying;LIN Peng;LIU Chenggang(Department of Trauma Orthopedics, China-Japan Friendship Hospital, Beijing 100029, China)

机构地区：[1]中日友好医院骨科三部,北京100029

出　　处：《中国骨质疏松杂志》2019年第2期169-173,共5页Chinese Journal of Osteoporosis

基　　金：国家自然科学基金面上项目(81672236;81372013);北京市自然科学基金面上项目(7182146)

摘　　要：目的探讨股骨干骨折经顺行髓内钉治疗后与股骨头坏死发生的关系。方法对我院诊治的47例采用顺行髓内钉治疗的股骨干骨折患者进行回顾性研究;平均年龄55.3岁(18～95岁);男31例,女16例。骨折的AO分型:A型14例,B型27例,C型6例。车祸所致者14例,高处坠落者11例,摔倒者22例。大转子顶点进钉38例,梨状窝进钉9例。采用卡方检验探索骨折分型、年龄、是否合并骨质疏松、进钉点位置与股骨头坏死的关系。当期望计数小于5时,采用Fisher精确检验结果。结果股骨头坏死发生与年龄、AO分型、骨质疏松无明显相关性,进钉点位置的选取对发生股骨头坏死有显著性影响(P<0.05)。3例股骨头坏死患者均采用了梨状窝进钉点。结论进钉点选择不当可能造成股骨头血供受损,针对髓内钉治疗股骨干骨折推荐采用大转子顶点作为进钉点。Objective To analyze the relationship between osteonecrosis of the femoral head(ONFH) and the intramedullary nailing treatment of femoral shaft fractures. Methods A retrospective study was conducted in 47 patients with an average age of 55.3 years old(18-95 years old) who underwent intramedullary nailing treatment of femoral shaft fractures in our hospital, including 31 males and 16 females. According to the AO classification of the fracture, there were 14 cases of type A, 27 cases of type B, and 6 cases of type C. There were 14 cases caused by car accident, 11 cases caused by falling high, and 22 cases caused by fall. The number of cases with the entry point at the tip of the greater trochanter or piriformis fossa was 38 and 9, respectively. The relationship between type of fracture, age, accompanied with osteoporosis, the entry point of the nail, and ONFH was examined using Chi-square test, or Fisher’s exact test when expected frequency was 5 or less. Results There was no significant correlation between ONFH and age, AO classification, and osteoporosis. The entry point had significant effect on ONFH(P<0.05). The entry point of the three ONFH cases were all at the piriformis fossa. Conclusion Inappropriate entry point of the nail may cause damage to the blood supply of the femoral head. The entry point at the tip of the greater trochanter should be recommended for the treatment of femoral shaft fractures with intramedullary nail.

关 键 词：股骨干骨折 股骨头坏死 髓内钉 并发症 骨质疏松 

分 类 号：R681[医药卫生—骨科学]