股骨颈骨折内固定术后股骨头坏死的因素  

Factors related to femoral head necrosis after internal fixation of femoral neck fracture

作　　者：张迪 顾挺[1] 牛瑶[1] 刘扬[1] ZHANG Di;GU Ting;NIU Yao;LIU Yang(The First Affiliated Hospital,Xinjiang Medical University,Urumqi,Xinjiang 830054,China)

机构地区：[1]新疆医科大学第一附属医院,新疆乌鲁木齐830054

出　　处：《中国矫形外科杂志》2025年第6期561-565,共5页Orthopedic Journal of China

基　　金：新疆维吾尔自治区自然科学基金项目(编号:2021D01C332)。

摘　　要：[目的]探讨股骨颈骨折(femoral neck fracture,FNF)内固定术后股骨头坏死(femoral head necrosis,FHN)的因素。[方法]2021年1月—2023年1月100例FNF患者在全麻下接受骨折复位内固定治疗,术后平均随访(2.1±0.4)年,观察FHN发生情况。比较并分析FHN组与非FHN组一般资料,以及血清内皮素-1(Endothelin-1,ET-1)和基质金属蛋白酶-13(matrix metalloproteinase,MMP-13)。[结果]100例患者中21例发生FHN。单项因素比较表明,FHN组Garden分型严重程度比率[例,I~II/III~IV,(8/13)vs(58/21),P=0.002]、合并糖尿病比率[例,是/否,(7/14)vs(10/69),P=0.025]、合并高血压[例,是/否,(8/13)vs(13/66),P=0.030]、血清ET-1水平[(7.8±1.8)μg/L vs(6.4±1.5)μg/L,P<0.001]、MMP-13水平[(42.1±4.3)μg/L vs(36.4±4.0)μg/L,P<0.001]均显著高于非FHN组,尽管两组在年龄、性别、体质指数、骨折侧别、骨折原因的差异均无统计学意义(P>0.05)。二元多因素逻辑回归表明,Garden分型重(OR=3.056,95%CI:1.597~11.686)、合并糖尿病(OR=2.430,95%CI:1.640~8.790)、血清ET-1水平高(OR=2.694,95%CI:1.537~9.570)、MMP-13水平高(OR=2.745,95%CI:1.455~10.708)是FNF患者内固定术后FHN的危险因素。[结论]血清ET-1、MMP-13与FNF患者术后FHN关系密切。[Objective]To explore the factors related to femoral head necrosis(FHN)after internal fixation of femoral neck fracture(FNF).[Methods]From January 2021 to January 2023,100 patients received reduction and internal fixation under general anesthesia for FNF,and followed up for a mean of(2.1±0.4)years to observe whether FHN happened.The general data and serum levels of endothelin-1(ET-1)and matrix metalloproteinase(MMP-13)were compared and analyzed between the FHN group and non-FHN group.[Results]FHN occurred in 21 of the 100 patients.In term of univariate comparison,the FHN group proved significantly greater than the non-FHN group regarding to ratio of severe Garden classification[I~II/III~IV,(8/13)vs(58/21),P=0.002],the ratio of combined diabetes[yes/no,(7/14)vs(10/69),P=0.025],combined hypertension[yes/no,(8/13)vs(13/66),P=0.030],serum levels of ET-1[(7.8±1.8)μg/L vs(6.4±1.5)μg/L,P<0.001]and MMP-13[(42.1±4.3)μg/L vs(36.4±4.0)μg/L,P<0.001],despite of the fact that there were no statistically significant differences in age,sex,body mass index,fracture side and fracture cause between the two groups(P>0.05).As results of binary multi-factor logistic regression,the severe Garden grade(OR=3.056,95%CI:1.597~11.686),diabetes mellitus(OR=2.430,95%CI:1.640~8.790),high serum ET-1 level(OR=2.694,95%CI:1.537~9.570)and high level of MMP-13(OR=2.745,95%CI:1.455~10.708)were risk factors for FHN after internal fixation of FNF.[Conclusion]Serum ET-1 and MMP-13 are closely related to postoperative FHN in patients who had FNF fixed.

关 键 词：血清内皮素-1 基质金属蛋白酶-13 股骨颈骨折 术后股骨头坏死 

分 类 号：R683.42[医药卫生—骨科学]