成年股骨颈骨折愈合后内固定物取出术后短期随访  

Short term follow-up after removal of internal fixation after femoral neck fracture healing in adults

作　　者：杨德育 尤瑞金 郑耿阳 Yang Deyu;You Ruijin;Zheng Gengyang(Department of Orthopaedics?PLA No.910 Hospital,Quanzhou 362000,China)

机构地区：[1]福建泉州解放军联勤保障部队第910医院骨科,362000

出　　处：《中华关节外科杂志（电子版）》2022年第4期483-487,共5页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的:研究取出股骨颈内固定物术后短期内对股骨头的影响。方法:自2014年3月至2018年1月解放军第910骨科进行了68例股骨颈骨折复位内固定术,32例骨折愈合后行内固定物取出术。根据有无取出内固定物分为取出组32例及保留组36例。采用两独立样本t检验、卡方检验、Fisher确切概率法及重复测量方差分析比较两组一般情况、骨折愈合时间、股骨头坏死率、Harris髋关节评分。结果:取出组随访时间平均(31.7±6.8)个月;末次随访时钉道愈合率21.9%,股骨头坏死发生率34.4%;术前Harris髋关节评分平均(12±3)分,末次随访时评分平均(84±20)分。保留组随访时间平均(32.7±7.0)个月;末次随访股骨头坏死发生率8.3%;术前Harris髋关节评分(13±4)分,末次随访时评分平均(91±14)分。保留组在股骨头坏死率(t=7.027)及末次随访Harris髋关节评分(F=7.835)优于取出组(均为P<0.05)。结论:因生物力学改变,股骨颈内固定物取出后,短期内钉道愈合率低,增加股骨头坏死率,导致髋关节功能变差。Objective To study the short-term effect on femoral head after removal of femoral neck internal fixation.Methods From March 2014 to January 2018,68 cases of adult patients with femoral neck fracture received reduction and internal fixation of femoral neck fracture,Among them,32 cases were treated with removal of femoral neck internal fixation after fracture healing.According to whether the internal fixation was removed,the patients were divided into the removal group(32 cases)and the retention group(36 cases).Two independent samples t test,chi square test,Fisher exact probability method and repeated measurement AN OVA were used to compare the general situation,fracture healing time,femoral head necrosis rate and Harris hip score between the two groups.Results The follow-up time of the removal group was(31.7±6.8)months.At the last follow-up,the healing rate of the removal group was 21.9%,the incidence of femoral head necrosis was 34.4%.Harris hip score of the removal group before the operation was(12±3);at the last follow-up,the Harris hip score was(84±20).The follow-up time of the retention group was(32.7±7.0)months.At the last follow-up,the incidence of femoral head necrosis of the retention group was 8.3%.The Harris hip score of the retention group before operation was(13±4),and(91±14)at the last follow-up.The femoral head necrosis rate(t=7.027)and Harris hip score of the retention group(F=7.835)were better than the removal group(both P<0.05).Conclusion Because of the biomechanical changes,the healing rate of the nail path is low in a short time after the removal of the femoral neck internal fixation,which increases the incidence of femoral head necrosis and leads to the deterioration of hip joint function.

关 键 词：股骨颈 股骨头坏死 内固定器 装置取出 

分 类 号：R687.3[医药卫生—骨科学]