新鲜股骨颈骨折行闭合复位三枚空心螺钉加压固定治疗的临床疗效及影响临床结局的因素分析  

Clinical effect and its affecting factors of internal fixation for fresh femoral neck fractures with three cannulated screws

作　　者：黄兆波[1] 尤加省[1] 杨杰[1] HUANG Zhaobo;YOU Jiaxing;YANG Jie(Department of Orthopaedics,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院(下沙院区)骨科,浙江杭州310016

出　　处：《全科医学临床与教育》2020年第12期1080-1083,共4页Clinical Education of General Practice

摘　　要：目的探析闭合复位下三枚空心螺钉加压固定治疗股骨颈骨折的临床疗效及影响临床结局的因素。方法回顾性分析100例采取三枚空心螺钉加压固定治疗股骨颈骨折患者的临床资料,包括患者年龄、性别、骨折类型是否移位、体重指数等,并且观察临床疗效,包括骨折复位质量、末次随访时髋关节Harris功能评分、股骨颈短缩及股骨头塌陷坏死发生率等,分析影响髋关节Harris功能评分及股骨颈短缩和股骨头塌陷坏死的相关因素。结果本组患者随访时间12~48个月,末次随访Harris功能评分平均(86.21±6.06)分,其中优34例、良45例、一般19例、差2例,总体优良率79.00%。共有20例患者发生股骨颈短缩或股骨头塌陷坏死(其中8例发生股骨头塌陷坏死、12例出现股骨颈短缩改变)。多因素logistic回归显示复位质量是影响股骨颈短缩和股骨头塌陷坏死的主要危险因素(OR=6.49,P<0.05),年龄、骨折类型和复位质量是影响术后髋关节Harris功能评分的保护因素(t分别=-2.68、-4.23、-3.75,P均<0.05)。结论三枚空心螺钉加压固定治疗新鲜股骨颈骨折总体临床疗效较满意,高龄、移位型股骨颈骨折及复位质量不良是导致发生不良临床结局的危险因素。Objective To explore the clinical effect and its affecting factors of the clinical results after fixation of femoral neck fractures with three cannulated screws.Methods Totally 100 patients with femoral neck fractures who treated with three cannulated screws were retrospectively analyzed.Basic data including age,gender,fracture type and body mass index(BMI)were collected.The quality of fracture reduction,hip Harris score,femoral neck shortening and femoral head necrosis were also investigated.One way AVONA and regression analysis were performed to explore the factors affecting the Harris score and femoral neck shortening or femoral head necrosis.Results The follow-up was performed from 12 to48 months.The average hip Harris score of the final follow up was 86.21±6.06.There were 34 excellent cases,45 good cases,19 general cases and 2 poor cases,with an overall excellent and good rate of 79.00%.There were 12 patients with femoral neck shortening and 8 patients with femoral head necrosis.The regression analysis showed that reduction quality was risk factor of incidence of femoral neck shortening or femoral head necrosis(OR=6.49,P<0.05).Reduction quality,age,and type of fracture were associated with the final hip Harris score(t=-2.68,-4.23,-3.75,P<0.05).Conclusion The clinical effect of femoral neck fractures treated with three cannulated screws fixation is satisfactory generally.Old age,displaced fracture type,and poor reduction quality are associated with poor clinical results.

关 键 词：股骨颈骨折 空心螺钉固定 髋关节功能 股骨颈短缩 股骨头坏死 

分 类 号：R687.3[医药卫生—骨科学]