股骨头负重区压缩对老年髋臼骨折切开复位内固定术后疗效的影响  

The effects of weight-bearing area compression injury of the femoral head on the outcomes of elderly acetabular fractures after open reduction and internal fixation

作　　者：王虎[1] 马吉海 蔡明建 魏星[1] 严新安 黄海[1] 尚昆 邓洪利 付亚辉[1] 雷金来[1] 王鹏飞[1] 张斌飞[1] 丛雨轩 张堃[1] 庄岩[1] Wang Hu;Ma Jihai;Cai Mingjian;Wei Xing;Yan Xin'an;Huang Hai;Shang Kun;Deng Hongli;Fu Yahui;Lei Jinlai;Wang Pengfei;Zhang Binfei;Cong Yuxuan;Zhang Kun;Zhuang Yan(Department of Pelvic and Acetabular Surgery,Honghui Hospital,Xi'an Jiaotong University,Xi'an 710054,China;Department of Orthopaedic Surgery,Linxia Chinese Traditional Medicine Hospital,Linxia 731100,China;The First Clinical Medical College of Shaanxi University of Traditional Chinese Medicine,Xianyang 712046,China)

机构地区：[1]西安交通大学医学院附属红会医院创伤骨科环骨盆病区,710054 [2]临夏回族自治州中医医院骨科,731100 [3]陕西中医药大学第一临床医学院,咸阳712046

出　　处：《中华骨科杂志》2021年第19期1434-1442,共9页Chinese Journal of Orthopaedics

基　　金：陕西省重点研发计划(2019SF-120);西安市科技局科技行动计划医学研究项目(20YXYJ0004(7));陕西省科学技术厅创新人才推进计划-青年科技新星项目(2021KJXX-57);。

摘　　要：目的评估股骨头负重区压缩对老年髋臼骨折切开复位内固定术后疗效的影响。方法回顾性分析2014年1月至2018年1月采用切开复位内固定术治疗的合并股骨头负重区压缩损伤的老年髋臼骨折患者36例,男22例、女14例;年龄(73.2±6.5)岁(范围60~87岁)。术中对股骨头负重区压缩未行处理。髋臼骨折按照Letournel-Judet分型:双柱骨折14例,前柱+后半横断骨折12例,"T"形骨折4例,横断骨折4例,后柱+后壁骨折2例;其中14例伴髋臼关节面压缩,29例伴关节脱位。随访时采用Merle d’Aubigné评分评价髋关节功能、Matta分类法评价髋臼骨折复位、Kellgren-Lawrence分级评估髋关节创伤性关节炎、Ficat-Alert分期评估股骨头坏死。将随访期间出现股骨头坏死Ⅲ期、Ⅳ期或创伤性关节炎Ⅲ、Ⅳ级或接受关节置换术定义为手术失效。术前、术后(第2~5天)行骨盆CT扫描,于冠状面、横断面片测量股骨头压缩大小,并计算压缩体积。将压缩严重程度按照体积大小分为小(<1 cm^(3))、中(1~2 cm^(3))、大(>2 cm^(3))。采用二项Logistic回归分析术后股骨头压缩体积是否为手术失效的危险因素。结果病例随访(34.7±8.9)个月(范围25~54个月)。术前测量大、中、小体积股骨头压缩患者分别为7例、14例、15例;术后分别为12例、10例、14例。Matta分类:优6例、良22例、差8例,优良率78%(28/36)。末次随访时Merle d’Aubignés评分为优2例、良8例、可5例、差21例,优良率28%(10/36)。随访期间发生手术失效20例,失效率56%(20/36)。手术失效组与非手术失效组患者年龄、体质指数、手术时间、术中出血量、骨折类型、骨折复位Matta分类、合并髋臼关节面压缩及合并关节脱位的比例的差异无统计学意义,而术后股骨头负重区压缩体积频数分布的组间差异有统计学意义(χ2=22.047,P<0.001)。股骨头负重区域大、中、小体积压缩患者的手术失效率分别为92%、8Objective To evaluate the effects of weight-bearing area compression injury of the femoral head on the prognosis of elderly acetabular fractures after open reduction and internal fixation.Methods A retrospective analysis of 36 elderly patients with acetabular fractures treated with open reduction and internal fixation during January 2014 to January 2018 were conducted.All patients with compression injury of the weight-bearing area of the femoral head,including 22 males and 14 females with 73.2±6.5 years old(range 60-87 years old),were included.The compression injury of weight-bearing area of the femoral head was not treated.According to the Letournel-Judet classification of acetabular fractures,there were 14 cases with both-column,12 cases with anterior column and posterior hemitransverse,4 cases with T type,4 cases with transverse,and 2 cases with posterior column+posterior wall.A total of 14 cases were accompanied by acetabular joint surface compression,while 29 cases were accompanied by joint dislocation.The Merle d'Aubignéscore was used to evaluate the hip function during follow-up.The Matta classification method was used to evaluate the results of acetabular fracture reduction.The Kellgren-Lawrence classification standard and Ficat-Alert staging method were used to evaluate the traumatic arthritis of the hip and femoral head necrosis,respectively.During the follow-up,the femoral head necrosis with stage III,IV,or traumatic arthritis III,IV,or with indications for joint replacement was defined as surgery failure.CT scans of the pelvis were performed before and at 2-5 days after operation.The compression size of the femoral head on the coronal and axial planes of the CT scan was calculated for the compression volume.The compression severity was divided into small(<1 cm^(3)),medium(1-2 cm^(3))and large(>2 cm^(3))according to the volume.Binary Logistic regression analysis was used to analyze whether the postoperative measurement of the femoral head compression volume was associated with the risk of surgical fa

关 键 词：髋臼 骨折 股骨头 骨折固定术 内 治疗失败 危险因素 

分 类 号：R687.3[医药卫生—骨科学]