一种术中判断股骨颈骨折后股骨头血供的方法研究  

Intraoperative assessment of blood supply to the femoral head after femoral neck fracture

作　　者：谌晖 张浩[1] 成衍男 段平 王涵宇 邓宇[1] 潘振宇[1] Chen Hui;Zhang Hao;Cheng Yannan;Duan Ping;Wang Hanyu;Deng Yu;Pan Zhenyu(Department of Orthopaedic Trauma and Microsurgery,Zhongnan Hospital of Wuhan University,Wuhan 430062,China)

机构地区：[1]武汉大学中南医院创伤与显微骨科,武汉430062

出　　处：《中华创伤骨科杂志》2023年第6期523-529,共7页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金(81972066)。

摘　　要：目的探讨一种术中判断股骨颈骨折后股骨头血供的方法,以及血供情况与术后股骨头坏死的相关性。方法回顾性分析2016年4月至2021年3月期间武汉大学中南医院创伤与显微骨科采用切开复位空心加压螺钉内固定治疗的63例移位型股骨颈骨折患者资料。男39例,女24例;年龄(44.9±13.6)岁;骨折Garden分型:Ⅲ型42例,Ⅳ型21例;受伤至手术时间(4.1±2.4)d。内固定手术完成后,在股骨头颈交界处上方2.0 cm处用2.0 mm克氏针钻孔,观察钻孔处血液流出速度、颜色及性状等。根据渗血情况将患者分为渗血良好组(51例,在钻孔15 s内可见鲜红色血液渗出)和渗血不良组(12例,在钻孔15 s以上渗出暗红色血液)。比较两组患者术后股骨头坏死的发生情况、髋关节Harris评分及疼痛视觉模拟评分(VAS)等。运用Cox回归模型对股骨颈骨折患者术后发生股骨头坏死的影响因素进行分析。结果63例患者术后获24(18,36)个月随访。两组患者的术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。渗血良好组和渗血不良组分别有3、5例患者发生股骨头坏死,差异有统计学意义(P<0.05)。渗血良好组患者术后1年髋关节Harris评分[90.0(86.0,92.0)分]和疼痛VAS评分[1.0(1.0,2.0)分]显著优于渗血不良组患者[85.5(71.3,88.8)、2.5(1.0,3.8)分],差异均有统计学意义(P<0.05)。多因素Cox回归分析结果显示:骨折Garden分型Ⅳ型(HR=6.784,95%CI:1.324~35.664,P=0.023)和术中渗血不良(HR=10.744,95%CI:2.359~51.774,P=0.003)是移位型股骨颈骨折空心加压螺钉固定术后股骨头坏死的危险因素(P<0.05)。结论切开复位内固定后在股骨头上钻孔能直观判断股骨颈骨折后股骨头的血供情况。术中渗血不良是移位型股骨颈骨折空心加压螺钉固定术后股骨头坏死的危险因素。Objective To explore intraoperative assessment of blood supply to the femoral head after femoral neck fracture,and the correlation between the blood supply and postoperative osteonecrosis of the femoral head.Methods A retrospective analysis was performed of the 63 patients with femoral neck fracture who had been treated at Department of Orthopaedic Trauma and Microsurgery,Zhongnan Hospital of Wuhan University by open reduction and internal fixation with hollow compression screws from April 2016 to March 2021.They were 39 males and 24 females with an age of(44.9±13.6)years.There were 42 cases of Garden typeⅢand 21 cases of Garden typeⅣ.Time from injury to operation was(4.1±2.4)days.After internal fixation,a hole was drilled using a 2.0 mm Kirschner wire at 2.0 cm above the femoral head-neck junction to observe the velocity,color,and characteristics of the blood oozing at the drill hole.The patients were divided into a good oozing group of 51 cases in whom bright red blood oozing was observed within 15 seconds after drilling and a poor oozing group of 12 cases in whom dark red blood oozing was observed beyond 15 seconds after drilling.The incidence of postoperative femoral head necrosis,Harris hip score,and visual analogue scale(VAS)for pain were compared between the 2 groups.Single factor and multi factor analyses were conducted using the Cox regression model to analyze the factors influencing postoperative femoral head necrosis in the patients.Results The 63 patients were followed up for 24(18,36)months.The 2 groups were comparable because there was no significant difference in the preoperative general data between them(P>0.05).Femoral head necrosis was observed in 3 cases in the good oozing group and in 5 cases in the poor oozing group,showing a significant difference between the 2 groups(P<0.05).The Harris hip score[90.0(86.0,92.0)]and the VAS pain score[1.0(1.0,2.0)]at 1 year after surgery in the good oozing group were significantly better than those in the poor oozing group[85.5(71.3,88.8)and 2.5(1.0,3.

关 键 词：股骨颈骨折 血供 术中观察 GARDEN分型 

分 类 号：R687.3[医药卫生—骨科学]