压力侧和张力侧股骨颈皮质粉碎是股骨颈骨折术后无菌性坏死的独立危险因素  

Pressure side and tension side comminution of femoral neck cortex are independent risk factors for aseptic necrosis after femoral neck fracture surgery

作　　者：陈芒芒 吕杨训 林胜磊 黄力鹏 董启榕[2] CHEN Mang-mang;LYU Yang-xun;LIN Sheng-lei;HUANG Li-peng;DONG Qi-rong(Wenzhou Central Hospital,Wenzhou 325000,Zhejiang,China;不详)

机构地区：[1]温州市中心医院,浙江温州325000 [2]苏州大学附属第二医院,江苏苏州215000

出　　处：《中国骨伤》2021年第3期203-208,共6页China Journal of Orthopaedics and Traumatology

基　　金：温州市科技计划项目(编号:Y20180319)。

摘　　要：目的:探讨股骨颈骨折闭合复位内固定术后发生股骨头无菌性坏死的相关影响因素。方法:2009年1月至2016年1月,采用闭合复位3枚中空拉力螺钉内固定治疗236例股骨颈骨折患者,男111例,女125例;年龄19~89(50.17±12.88)岁。根据随访结果分析其发生股骨头无菌性坏死的相关性。对年龄、性别、损伤侧、体重、损伤机制、术前等待时间、Garden分型和是否有股骨颈皮质粉碎等单因素分析得到显著性差异的自变量,然后进行二元Logistic回归分析,探讨股骨头无菌性坏死的独立危险因素。结果:236例病例平均随访4.58年,高能损伤(24.69%vs.5.16%,χ^(2)=19.405,P=0.000),术前等待时间>48 h(20.00%vs.6.38%,χ^(2)=10.065,P=0.002),GardenⅢ/Ⅳ型(18.52%vs.2.97%,χ^(2)=13.357,P=0.000),股骨颈皮质粉碎(66.67%vs.4.88%,χ^(2)=39.968,P=0.000)差异有统计学意义。多元Logistic回归分析表明:损伤机制[高能损伤,Exp(B)=4.397,95%CI=(1.672-11.562),P=0.003],术前等待时间>48 h[Exp(B)=3.060,95%CI=(1.176-7.966),P=0.022],股骨颈皮质粉碎[股骨颈压力侧皮质粉碎,Exp(B)=3.944,95%CI=(1.245-12.494),P=0.020;股骨颈压力侧和张力侧皮质均粉碎,Exp(B)=23.761,95%CI=(3.805-148.374),P=0.001]是股骨颈骨折内固定术后股骨头无菌性坏死的独立危险因素。而GardenⅢ/Ⅳ型并非独立危险因素[Exp(B)=1.985,95%CI=(0.436-9.032),P=0.375]。结论:高能量损伤、术前等待时间(>48 h)和股骨颈皮质粉碎是影响股骨头无菌性坏死的独立危险因素。此外,股骨颈压力侧和张力侧皮质粉碎是股骨头无菌性坏死的一个很强的预后危险因素,因为它表明了一种更严重复杂的损伤机制。Objective:To investigate the related factors of aseptic necrosis of femoral head after closed reduction and internal fixation of femoral neck fracture.Methods:From January 2009 to January 2016,236 patients with femoral neck fracture were treated with closed reduction and internal fixation with 3 hollow lag screws,including 111 males and 125 females,aged from 19 to 89(50.17±12.88)years.According to the follow-up results,the correlation of aseptic necrosis of femoral head was analyzed.Univariate analysis of age,gender,injured side,body weight,injury mechanism,preoperative waiting time,Garden classification and whether there was comminution of femoral neck cortex was conducted to obtain the independent variables with significant difference.Then binary logistic regression analysis was conducted to explore the independent risk factors of avascular necrosis of femoral head.Results:The average follow-up period of 236 cases was 4.58 years.There were significant differences in the range of injury(24.69%vs.5.16%,χ^(2)=19.405,P=0.000),operation waiting time>48 hours(20.00%vs.6.38%,χ^(2)=10.065,P=0.002),Garden typeⅢ/Ⅳ(18.52%vs.2.97%,χ^(2)=13.357,P=0.000),femoral neck cortex comminution(66.67%vs.4.88%,χ^(2)=39.968,P=0.000).Multivariate logistic regression analysis showed that:injury mechanism[high energy injury,Exp(B)=4.397,95%CI=(1.672-11.562),P=0.003],preoperative waiting time>48 h[Exp(B)=3.060,95%CI=(1.176-7.966),P=0.022],comminution of femoral neck cortex[comminution of femoral neck pressure side cortex,Exp(B)=3.944,95%CI=(1.245-12.494),P=0.020];comminution of femoral neck pressure side and tension side cortex,Exp(B)=23.761,95%CI=(3.805-148.374),P=0.001.were independent risk factors for avascular necrosis after inter nal fixation of femoral neck fracture.Garden typeⅢ/Ⅳwas not an independent risk factor in this study[Exp(B)=1.985,95%CI=(0.436-9.032),P=0.375].Conclusion:High energy injury,preoperative waiting time(>48 h)and comminution of femoral neck cortex were independent risk factors for aseptic necrosis of

关 键 词：皮质骨 骨折 粉碎性 股骨颈骨折 股骨头坏死 

分 类 号：R683.42[医药卫生—骨科学]