PauwelsⅢ型股骨颈骨折闭合复位内固定术后缺血性股骨头坏死的多因素分析  

Multivariate Analysis of Ischemic Femoral Head Necrosis After Closed Reduction and Internal Fixation for Pauwels TypeⅢ Femoral Neck Fracture

作　　者：张雅文 侯国进[1] 周方[1] 田耘[1] 姬洪全[1] 张志山[1] 郭琰[1] 吕扬[1] 杨钟玮 Zhang Yawen;Hou Guojin;Zhou Fang(Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China)

机构地区：[1]北京大学第三医院骨科,北京100191

出　　处：《中国微创外科杂志》2020年第12期1057-1062,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：北京大学第三医院临床重点项目(BYSY2017014)。

摘　　要：目的探讨PauwelsⅢ型股骨颈骨折闭合复位内固定术后缺血性股骨头坏死(avascular necrosis,AVN)的影响因素。方法对2012年1月~2017年12月79例随访时间>1年的PauwelsⅢ型股骨颈骨折进行回顾性研究,发生AVN 27例。记录性别、年龄、BMI、美国麻醉医师协会(American Society of Anesthesiology,ASA)分级、受伤原因、骨折侧别、Garden分型、骨折线位置、Pauwels角、受伤至手术时间、内固定方式、手术时间、复位质量。内固定方式采用3枚平行空心钉加压固定(cannulated compression screw,CCS)(35例)或动力髋螺钉(dynamic hip screw,DHS)+空心钉固定(44例)。采用单因素和多因素logistic回归分析术后AVN的影响因素。结果单因素分析显示无AVN组和AVN组BMI、Garden分型及复位质量的差异具有统计学意义(P<0.05)。多因素logistics回归分析显示BMI>25(OR=6.117,95%CI:1.668~22.436,P=0.006)、Garden分型Ⅳ型(OR=10.696,95%CI:1.808~63.258,P=0.009)及复位质量C级(OR=23.843,95%CI:2.180~260.760,P=0.009)是术后AVN的独立预后因素。结论股骨颈骨折内固定术后股骨头坏死受BMI、Garden分型及复位质量等多方面因素的影响,治疗前应完善评估并给予针对性干预。Objective To investigate the influencing factors of avascular necrosis(AVN)after closed reduction and internal fixation of Pauwels typeⅢfemoral neck fractures.Methods From January 2012 to December 2017,79 cases of Pauwels typeⅢfemoral neck fractures with a follow-up time of more than 1 year were retrospectively studied.AVN occurred in 27 cases.The gender,age,BMI,American Society of Anesthesiology(ASA)classification,cause of injury,fracture side,Garden classification,fracture line position,Pauwels angle,time from injury to operation,internal fixation method,operation time,and reset quality were recorded.The internal fixation method included 3 parallel cannulated compression screws(CCS)fixation(35 cases)or dynamic hip screw(DHS)+hollow nail fixation(44 cases).Univariate analysis and multivariate logistic regression were used to analyze the influencing factors of AVN after operation.Results Univariate analysis showed that there were statistically significant differences in BMI,Garden classification and reduction quality between the non-AVN group and the AVN group(P<0.05).Multivariate logistics regression analysis showed that BMI>25(OR=6.117,95%CI:1.668-22.436,P=0.006),Garden TypeⅣ(OR=10.696,95%CI:1.808-63.258,P=0.009)and grade C of reduction quality(OR=23.843,95%CI:2.180-260.760,P=0.009)were independent prognostic factors of postoperative AVN.Conclusions AVN after internal fixation of Pauwels typeⅢfemoral neck fractures is affected by many factors such as BMI,Garden classification and reduction quality.Before treatment,a complete assessment and targeted intervention should be given.

关 键 词：股骨颈骨折 股骨头坏死 预后因素 

分 类 号：R68[医药卫生—骨科学]