股骨颈骨折术后股骨头缺血坏死的发生率及危险因素分析  

Incidence rate and risk factors analysisof the avascular necrosis of femoral head after femoral neck fracture

作　　者：霍喜卫[1] 李东风[1] 胡成栋[1] 王瑞[1] 王飞[1] 周玉军[1] HUO Xi-wei;LI Dong-feng;HU Cheng-dong;WANG Rui;WANG Fei;ZHOU Yu-jun(Department of Orthopedics,Handan Central Hospital,Handan Hebei 056001,China)

机构地区：[1]河北省邯郸市中心医院骨科,056001

出　　处：《蚌埠医学院学报》2021年第8期1050-1053,共4页Journal of Bengbu Medical College

基　　金：河北省医学科学研究课题计划(20191860)。

摘　　要：目的:探讨股骨颈骨折术后股骨头发生缺血坏死的概率和危险因素。方法:回顾性分析272例中青年股骨颈骨折病人的临床资料,均实施闭合复位加压螺钉固定术治疗,根据术后是否发生股骨头坏死分为坏死组(37例)和愈合组(235例),对2组病人的受伤至手术时间、骨折侧别、手术时间、术前牵引、术前合并症、术前Garden分型、复位后Garden指数、髋关节Harris评分、血脂水平和术后下床活动时间进行比较,采用logistic回归分析探讨术后发生股骨头坏死的危险因素。结果:2组病人在术前Garden分型、复位后Garden指数、髋关节Harris评分、总胆固醇、三酰甘油等差异均有统计学意义(P<0.05~P<0.01)。术前Garden指数高、复位后Garden指数高、总胆固醇和三酰甘油高均为股骨头发生缺血性坏死的独立危险因素(P<0.05)。结论:股骨颈骨折术后股骨头坏死的危险因素包括总胆固醇及三酰甘油水平高、术前Garden分型高和骨折复位质量差。术中应尽量做到解剖复位,围手术期积极控制血脂水平,以期降低股骨头坏死的发生率。Objective:To explore the incidence rate and risk factors of the avascular necrosis of femoral head after femoral neck fracture.Methods:The clinical data of 272 femoral neck fracture patients treated with closed reduction and compression screw fixation were retrospectively analyzed.The patients were divided into the necrosis group(37 cases)and healing group(235 cases)according to whether having femoral head necrosis or not.The time from injury to operation,fracture side,operation time,preoperative traction,preoperative complications,preoperative Garden classification,Garden index after reduction,Harris hip score,blood lipid level and postoperative activity time were compared between two groups.The logistic regression analysis was used to investigate the risk factors of postoperative femoral head necrosis.Results:The differences of the preoperative Garden classification,Garden index after reduction,Harris hip score,total cholesterol and triglyceride between two groups were statistically significant(P<0.05 to P<0.01).The high Garden index before surgery,high Garden index after reduction,high total cholesterol and triglyceride were the independent risk factors of avascular necrosis of femoral head(P<0.05).Conclusions:The risk factors of femoral head necrosis after femoral neck fracture include the high levels of total cholesterol and triglyceride,high preoperative Garden classification and poor quality of fracture reduction.In order to reduce the incidence rate of the femoral head necrosis,the intraoperative anatomic reduction should be achieved as far as possible,and the perioperative lipid should be actively controlled.

关 键 词：股骨颈骨折 股骨头缺血坏死 血脂 中青年 相关因素 

分 类 号：R683.42[医药卫生—骨科学]