PauwelsⅢ型股骨颈骨折多枚空心螺钉内固定术后股骨头缺血性坏死的影响因素  

Influencing factors of avascular necrosis of femoral head in patients with Pauwels typeⅢfemoral neck fractures after internal fixation of multiple cannulated screws

作　　者：曹志[1] 汤立新[2] 王海宇 CAO Zhi;TANG Lixin;WANG Haiyu(Department of Orthopaedics,the Second Affiliated Hospital of Nanyang Medical College,Nanyang 473000,Henan Province,China;Department of Orthopedics,Nanyang Central Hospital,Nanyang 473000,Henan Province,China)

机构地区：[1]南阳医学高等专科学校第二附属医院骨一科,河南南阳473000 [2]南阳市中心医院骨一科,河南南阳473000

出　　处：《新乡医学院学报》2025年第1期52-56,共5页Journal of Xinxiang Medical University

摘　　要：目的探讨PauwelsⅢ型股骨颈骨折患者行多枚空心螺钉内固定术后股骨头缺血性坏死(ANFH)发生情况及其影响因素。方法选择2020年6月至2022年6月于南阳医学高等专科学校第二附属医院骨一科接受多枚空心螺钉内固定术治疗的148例PauwelsⅢ型股骨颈骨折患者为研究对象。随访1 a,依据是否发生ANFH将患者分为ANFH组和无ANFH组。比较2组患者的性别、年龄、体质量指数、骨折至手术时间、受伤原因、骨折侧别、骨折移位情况、术前是否行皮牵引、复位质量、内固定是否取出、术后开始负重时间等临床资料;应用logistic回归模型分析PauwelsⅢ型股骨颈骨折患者多枚空心螺钉内固定术后发生ANFH的影响因素,受试者操作特征(ROC)曲线分析相关影响因素对多枚空心螺钉内固定术后ANFH发生的预测价值。结果148例接受多枚空心螺钉内固定术治疗的PauwelsⅢ型股骨颈骨折患者中术后发生ANFH 24例,发生率为16.21%。ANFH组患者的年龄显著大于无ANFH组,骨折至手术时间显著长于无ANFH组,骨折移位、复位不良占比显著高于无ANFH组,术后开始负重时间显著短于无ANFH组(P<0.05);2组患者的性别、体质量指数、受伤原因、骨折侧别、术前是否行皮牵引、内固定是否取出比较差异无统计学意义(P>0.05)。Logistic回归模型分析结果显示,年龄大、骨折至手术时间长、骨折移位是PauwelsⅢ型股骨颈骨折患者行多枚空心螺钉内固定术后发生ANFH的危险因素[比值比(OR)=1.211、1.235、3.000,P<0.05],复位质量好、术后开始负重时间长是PauwelsⅢ型股骨颈骨折患者多枚空心螺钉内固定术后发生ANFH的保护因素(OR=0.275、0.010,P<0.05)。ROC曲线结果显示,年龄、骨折至手术时间、骨折移位、复位质量、术后开始负重时间预测PauwelsⅢ型股骨颈骨折患者行多枚空心螺钉内固定术后发生ANFH的曲线下面积分别为0.792、0.798、0.629、0.630、Objective To investigate the occurrence of avascular necrosis of femoral head(ANFH)in patients with Pauwels typeⅢfemoral neck fractures after internal fixation of multiple cannulated screws and influencing influencing factors.Methods A total of 148 patients with Pauwels typeⅢfemoral neck fractures who received internal fixation of multiple cannulated screws in the Second Affiliated Hospital of Nanyang Medical College from June 2020 to June 2022 were selected.The patients were followed up for 1 year,and they were divided into an ANFH group and a non-ANFH group according to where they developed ANFH.Clinical data including gender,age,body mass index,time from fracture to surgery,cause of injury,fracture side,fracture displacement,preoperative skin traction,reduction quality of fracture,removal of internal fixation,and time to start weight bearing after surgery were compared between the two groups.The influencing factors of ANFH occurrence in patients with Pauwels typeⅢfemoral neck fractures after internal fixation of multiple cannulated screws were analyzed by a logistic regression model.The receiver operating characteristic(ROC)curve was used to analyzed the value of influencing factors in predicting the occurrence of ANFH after internal fixation of multiple cannulated screws.Results Among 148 patients with Pauwels typeⅢfemoral neck fractures who received internal fixation of multiple cannulated screws,24 cases(16.21%)developed postoperative ANFH,with an incidence rate of 16.21%.Compared with those in the non-ANFH group,the age was significantly older,the time from fracture to surgery was significantly longer,the proportions of fracture displacement and poor reduction of fracture were significantly higher,and the time to start weight bearing after surgery was significantly shorter in the ANFH group(P<0.05).There was no statistically significant difference in gender,body mass index,cause of injury,fracture side,preoperative skin traction,and removal of internal fixation of patients between the two groups(P>

关 键 词：PauwelsⅢ型股骨颈骨折 空心螺钉内固定术 股骨头缺血性坏死 

分 类 号：R683.42[医药卫生—骨科学]