65岁以下嵌插型股骨颈骨折初始畸形程度对颈缩短的影响  

Effect of degree of initial deformity of impacted femoral neck fractures under 65 years of age on femoral neck shortening

作　　者：杜秀鹏 杨朝晖[1] Du Xiupeng;Yang Zhaohui(Department of Orthopedics,the Second Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China)

机构地区：[1]山西医科大学第二医院骨科,山西省太原市030001

出　　处：《中国组织工程研究》2021年第9期1410-1416,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:非手术治疗嵌插型股骨颈骨折是目前很少使用的一种策略,空心螺钉内固定是嵌插型股骨颈骨折的主要治疗方式。目前为止对嵌插型股骨颈骨折的研究主要集中在治疗方式与影响内固定失败的危险因素上,但嵌插型股骨颈骨折初始的畸形程度对术后股骨颈短缩影响的相关研究未见报道。目的:分析65岁以下嵌插型股骨颈骨折患者空心螺钉固定后股骨颈的短缩程度与初始畸形的关系,以及颈短缩对髋关节功能的影响。方法:纳入病历资料完整的嵌插型股骨颈骨折患者53例,均予以3枚空心螺钉内固定治疗。随访12-24个月,应用髋关节Harris评分评估患者功能恢复情况;治疗前对患者进行骨盆正位、髋关节侧位X射线检查,测量患侧股骨头后倾角、外翻角、Pauwels角;末次随访拍摄骨盆正位X射线片,计算关节-股骨转子间距指数下降百分比(代表股骨颈短缩程度),≥30%为明显短缩,<30%为不明显短缩,分析颈短缩的相关因素及对髋关节功能的影响。结果与结论:①53例患者全部骨愈合,无股骨头坏死等不良事件发生,其中有7例(13.2%)发生明显颈短缩;②独立样本t检验发现颈短缩与外翻角(P=0.000)、后倾角(P=0.001)、体质量指数(P=0.001)相关;Logistic回归分析发现外翻角是颈短缩的显著预测因子(P=0.041);③随着股骨颈短缩的增加,髋关节Harris评分降低,明显短缩组与不明显短缩组的髋关节Harris评分分别为(82.57±5.12)分和(94.15±4.03)分,差异有显著性意义;④提示外翻程度是嵌插型股骨颈骨折颈缩短的显著预测因子,并且股骨颈短缩与髋关节功能相关。BACKGROUND:Non-surgical treatment for impacted femoral neck fractures is a strategy rarely used at present.Hollow screw internal fixation is the main treatment for impacted femoral neck fractures.Studies on impacted femoral neck fractures so far have focused on treatment patterns and risk factors affecting internal fixation failure,but the effect of initial degree of deformity of impacted femoral neck fractures on postoperative femoral neck shortening was not studied.OBJECTIVE:To analyze the relationship between the degree of shortening and initial deformity of impacted femoral neck fractures after hollow screw fixation in patients under 65 years of age and the effect of femoral neck shortening on hip function.METHODS:Fifty-three impacted femoral neck fractures patients with complete medical records were included,and treated with three hollow screws for internal fixation.The patients were followed up for 12-24 months.Hip Harris score was used to evaluate the recovery of function.The posterior inclination angle,valgus angle,and Pauwels angle of the affected femoral head were measured by X-ray examination of pelvis and hip joint before treatment.X-ray films of pelvis were taken at the last follow-up to calculate the percentage of joint-coarsal distance decrease representing the degree of femoral neck shortening.Not less than 30%is significantly shortened(SFNS)and less than 30%is not significantly shortened(NSFNS).The related factors of neck shortening and the effect on hip function were analyzed.RESULTS AND CONCLUSION:(1)All 53 patients healed without adverse events such as femoral head necrosis.Seven cases(13.2%)had obvious neck shortening.(2)Independent-sample t-test found that neck shortening was associated with valgus angle(P=0.000),posterior dip angle(P=0.001)and body mass index(P=0.001).Logistic regression analysis found that valgus angle was a significant predictor of neck shortening(P=0.041).(3)The hip Harris score decreased with the increase of femoral neck shortening.The hip Harris scores were(82.57±5.12

关 键 词：骨 股骨 嵌插型 股骨颈骨折 内固定 颈短缩 外翻 

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