Zlowodzki M, Brink O, Switzer J, Wingerter S, Woodall J, Petrisor B A, Kregor P J, Bruinsma D R, Bhandari M
University of Minnesota, 2450 Riverside Avenue S, R200, Minneapolis, Minnesota 55454, USA.
J Bone Joint Surg Br. 2008 Nov;90(11):1487-94. doi: 10.1302/0301-620X.90B11.20582.
We have studied the effect of shortening of the femoral neck and varus collapse on the functional capacity and quality of life of patients who had undergone fixation of an isolated intracapsular fracture of the hip with cancellous screws. After screening 660 patients at four university medical centres, 70 patients with a mean age of 71 years (20 to 90) met the inclusion criteria. Overall, 66% (46 of 70) of the fractures healed with > 5 mm of shortening and 39% (27 of 70) with > 5 degrees of varus. Patients with severe shortening of the femoral neck had significantly lower short form-36 questionnaire (SF-36) physical functioning scores (no/mild (<5 mm) vs severe shortening (> 10 mm); 74 vs 42 points, p < 0.001). A similar effect was noted with moderate shortening, suggesting a gradient effect (no/mild (< 5 mm) vs moderate shortening (5 to 10 mm); 74 vs 53 points, p = 0.011). Varus collapse correlated moderately with the occurrence of shortening (r = 0.66, p < 0.001). Shortening also resulted in a significantly lower EuroQol questionnaire (EQ5D) index scores (p = 0.05). In a regression analysis shortening of the femoral neck was the only significant variable predictive of a low SF-36 physical functioning score (p < 0.001).
我们研究了股骨颈缩短和内翻塌陷对采用松质骨螺钉固定孤立性髋关节囊内骨折患者的功能能力和生活质量的影响。在四家大学医学中心对660例患者进行筛查后，70例平均年龄为71岁（20至90岁）的患者符合纳入标准。总体而言，66%（70例中的46例）骨折愈合时缩短超过5 mm，39%（70例中的27例）内翻超过5度。股骨颈严重缩短的患者的简短健康调查问卷（SF-36）身体功能评分显著更低（无/轻度（<5 mm）与严重缩短（>10 mm）相比；74分对42分，p<0.001）。中度缩短时也观察到类似效果，提示存在梯度效应（无/轻度（<5 mm）与中度缩短（5至10 mm）相比；74分对53分，p = 0.011）。内翻塌陷与缩短的发生呈中度相关（r = 0.66，p<0.001）。缩短还导致欧洲生活质量调查问卷（EQ5D）指数评分显著更低（p = 0.05）。在回归分析中，股骨颈缩短是预测SF-36身体功能评分低的唯一显著变量（p<0.001）。
