Duckworth A D, Bennet S J, Aderinto J, Keating J F
Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, UK.
J Bone Joint Surg Br. 2011 Jun;93(6):811-6. doi: 10.1302/0301-620X.93B6.26432.
The aim of this study was to determine the comorbid risk factors for failure in young patients who undergo fixation of a displaced fracture of the femoral neck. We identified from a prospective database all such patients ≤ 60 years of age treated with reduction and internal fixation. The main outcome measures were union, failure of fixation, nonunion and the development of avascular necrosis. There were 122 patients in the study. Union occurred in 83 patients (68%) at a mean follow-up of 58 months (18 to 155). Complications occurred in 39 patients (32%) at a mean of 11 months (0.5 to 39). The rate of nonunion was 7.4% (n = 9) and of avascular necrosis was 11.5% (n = 14). Failures were more common in patients over 40 years of age (p = 0.03). Univariate analysis identified that delay in time to fixation (> 24 hours), alcohol excess and pre-existing renal, liver or respiratory disease were all predictive of failure (all p < 0.05). Of these, alcohol excess, renal disease and respiratory disease were most predictive of failure on multivariate analysis. Younger patients with fractures of the femoral neck should be carefully evaluated for comorbidities that increase the risk of failure after reduction and fixation. In patients with a history of alcohol abuse, renal or respiratory disease, arthroplasty should be considered as an alternative treatment.
本研究的目的是确定接受股骨颈移位骨折内固定术的年轻患者失败的合并危险因素。我们从一个前瞻性数据库中识别出所有年龄≤60岁、接受复位内固定治疗的此类患者。主要观察指标为骨折愈合、内固定失败、骨不连及缺血性坏死的发生情况。本研究共纳入122例患者。83例患者（68%）实现骨折愈合，平均随访58个月（18至155个月）。39例患者（32%）出现并发症，平均时间为11个月（0.5至39个月）。骨不连发生率为7.4%（n = 9），缺血性坏死发生率为11.5%（n = 14）。40岁以上患者失败情况更为常见（p = 0.03）。单因素分析表明，固定时间延迟（> 24小时）、酗酒以及既往存在的肾脏、肝脏或呼吸系统疾病均为失败的预测因素（所有p < 0.05）。其中，多因素分析显示酗酒、肾脏疾病和呼吸系统疾病是失败的最强预测因素。对于股骨颈骨折的年轻患者，应仔细评估其合并症，这些合并症会增加复位和固定后失败的风险。对于有酗酒史、肾脏或呼吸系统疾病的患者，应考虑将关节置换作为替代治疗方法。
