股骨颈骨折复位内固定后股骨颈短缩的发生率及相关因素  

Incidence of femoral neck shortening after internal fixation of femoral neck fracture and prognostic factors

作　　者：牟帅 肖鹏[3] 张建亮 侯伟光 Mu Shuai;Xiao Peng;Zhang Jianliang;Hou Weiguang(Southwest Medical University,Luzhou 646000,Sichuan Province,China;Department of Orthopedics,Sichuan Bayi Rehabilitation Center·Affiliated Rehabilitation Hospital of Chengdu University of TCM,Chengdu 611135,Sichuan Province,China;Department of Lower Limbs,Sichuan Provincial Orthopedic Hospital,Chengdu 610041,Sichuan Province,China;Department of Lower Limbs,Pidu District Orthopedic Hospital of Chengdu City,Chengdu 617732,Sichuan Province,China;Department of Orthopedics,AVIC 363 Hospital,Chengdu 610041,Sichuan Province,China)

机构地区：[1]西南医科大学,四川省泸州市646000 [2]四川省八一康复中心·成都中医药大学附属康复医院骨科,四川省成都市611135 [3]四川省骨科医院下肢科,四川省成都市610041 [4]成都市郫都区骨科医院下肢科,四川省成都市617732 [5]航天工业三六三医院骨科,四川省成都市610041

出　　处：《中国组织工程研究》2020年第21期3304-3309,共6页Chinese Journal of Tissue Engineering Research

基　　金：四川省卫生和计划生育委员会重点课题(16ZD042)，项目参与人：牟帅~~

摘　　要：背景:空心钉内固定目前是临床上治疗股骨颈骨折最常用的方式,但部分患者术后可能出现股骨颈短缩的现象,甚至造成患者术后髋关节功能障碍的发生。目的:探讨股骨颈骨折复位内固定后股骨颈短缩的发生率、临床特点、预后转归及相关影响因素。方法:回顾性收集2012年1月至2017年3月成都地区3家骨科医院采用空心钉内固定治疗并获得完整术后随访信息的111例股骨颈骨折患者作为研究对象,所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。以术后股骨颈短缩作为预后观察指标,记录患者股骨颈短缩的发生率、发生时间及主要临床特点;采用单因素卡方检验分析性别、年龄、Garden分型、Garden指数、骨密度T值、Singh指数、受伤至手术时间、负重时间等因素与术后股骨颈短缩的相关关系,再将有统计学意义的因素纳入多因素Logistic回归模型分析。结果与结论:①股骨颈短缩发生率为48.6%(54/111),其中股骨颈短缩10-19 mm的发生率为31.5%(35/111)、股骨颈短缩≥20 mm的发生率为5.4%(6/111);②股骨颈短缩的发生时间主要集中在术后6个月内,占76%;③股骨颈短缩的临床症状主要包括下地负重时疼痛、髋关节活动受限和跛行,股骨颈短缩的临床表现分析结果显示,颈短缩组以中度疼痛为主(67%),无短缩组以无疼痛/轻度疼痛为主(86%);颈短缩组髋关节活动受限的发生率高于无短缩组(68%vs.21%),颈短缩组患者跛行的发生率高于无短缩组(61%vs.18%),差异均有显著性意义(P均<0.05);④单因素及多因素Logistic回归模型分析表明,骨折Garden分型为Ⅲ,Ⅳ型、Garden指数为Ⅲ,Ⅳ级、骨密度T值≤-2.5、负重时间≤2个月是股骨颈骨折复位内固定后发生股骨颈短缩的独立危险因素,说明股骨颈骨折空心钉内固定后存在很高的股骨颈短缩发生风险,而发生时间主要集中术后6个月内。BACKGROUND:Internal fixation with cannulated screws is the most commonly used treatment for femoral neck fracture,but some patients may have the phenomenon of femoral neck shortening after surgery,and even cause the occurrence of postoperative dysfunction of the hip joint.OBJECTIVE:To investigate the incidence,clinical features,prognosis and influencing factors of femoral neck shortening after internal fixation of femoral neck fracture.METHODS:One hundred and eleven cases of femoral neck fracture treated by cannulated screw internal fixation at three orthopedic hospitals in Chengdu from January 2012 to March 2017 were retrospectively analyzed.All patients signed the informed consents and the study was approved by the ethics committee of the hospital.Femoral neck shortening was as the prognostic indicator.The incidence,occurrence time and main clinical characteristics of femoral neck shortening after surgery were recorded.Univariate chi-square test was used to analyze the correlation between sex,age,Garden type,Garden index,bone mineral density T value,Singh index,time from injury to operation,weight-bearing time and the femoral neck shortening after surgery.Statistically significant factors were included in the multivariate Logistic regression model.RESULTS AND CONCLUSION:(1)The incidence of femoral neck shortening was 48.6%(54/111),with 31.5%(35/111)of 10-19 mm shortening and 5.4%(6/111)of≥20 mm shortening.(2)The occurrence time of femoral neck shortening was mainly within 6 months after surgery,accounting for 76%.(3)The clinical manifestations of the femoral neck shortening mainly included pain during weight-bearing,dysfunction of hip movement and claudication.The analysis results showed that the moderate pain(67%)was dominant in the shortening group,and no pain/mild pain(86%)was dominant in the non-shortening group;the incidence of hip motion limitation in the shortening group was higher than that in the non-shortening group(68%vs.21%);and the incidence of claudication in the shortening group was higher than

关 键 词：股骨颈骨折 骨折固定术 内 股骨颈短缩 影响因素 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]