手术时间对空心螺钉治疗股骨颈骨折并发症发生率的影响。

Influence of time to surgery on the incidence of complications in femoral neck fracture treated with cannulated screws.

作者信息

Araujo Thiego Pedro Freitas, Guimaraes Tales Mollica, Andrade-Silva Fernando Brandao, Kojima Kodi Edson, Silva Jorge Dos Santos

机构信息

Department of Orthopaedics and Traumatology, University of São Paulo, Brazil; Rua Ovidio Pires de Campos, São Paulo - SP, Brazil.

出版信息

Injury. 2014 Nov;45 Suppl 5:S36-9. doi: 10.1016/S0020-1383(14)70019-1.

DOI:10.1016/S0020-1383(14)70019-1

PMID:25528623

Abstract

BACKGROUND

Osteosynthesis of femoral neck fractures is particularly indicated in patients aged under 60 years. A prolonged interval between the fracture and surgical fixation has been associated with avascular necrosis (AVN) of the femoral head. The primary objective of this study was to evaluate the association between the time to surgery and the development of complications in patients with femoral neck fractures.

METHODS

Patients with displaced fractures of the femoral neck (Garden III or IV) who underwent fixation with three cannulated screws in the inverted triangle configuration from January 2009 to December 2010 were evaluated retrospectively for the development of orthopaedic complications. Patients were divided into two groups according to the time to surgery (within 7 days or more than 7 days). Complication rates were compared between the two groups. Regression analyses were performed to assess the risk factors for complications.

RESULTS

Thirty-one patients were included in the study; the duration of follow-up ranged from 24 to 50 months. The time from fracture to surgery ranged from 3 to 18 days. Fifteen patients underwent surgery within 7 days, and 16 patients underwent surgery after 7 days. There were four cases of femoral head necrosis. One patient had an associated infection; one patient experienced non-union, and another demonstrated osteosynthesis failure. There were no statistically significant differences in the overall rate of complications between the groups (p = 0.999). None of the preoperative parameters or fracture characteristics were predictive factors for complications. The only factor associated with the development of complications was inadequate fracture reduction in the anteroposterior (AP) view (odds ratio [OR] = 35.50, 95% confidence interval [CI] = 2.56 to 548.36, p = 0.008).

CONCLUSIONS

The interval between the occurrence of the injury and surgical fixation is not associated with the development of complications in fractures of the femoral neck. Inadequate fracture reduction in the AP view is a predictive factor for complications in these fractures.

摘要

背景

股骨颈骨折的骨合成尤其适用于60岁以下的患者。骨折与手术固定之间的间隔时间延长与股骨头缺血性坏死（AVN）有关。本研究的主要目的是评估股骨颈骨折患者手术时间与并发症发生之间的关联。

方法

回顾性评估2009年1月至2010年12月期间接受倒三角形配置的三枚空心螺钉固定的股骨颈移位骨折（Garden III或IV型）患者的骨科并发症发生情况。根据手术时间（7天内或超过7天）将患者分为两组。比较两组的并发症发生率。进行回归分析以评估并发症的危险因素。

结果

31例患者纳入研究；随访时间为24至50个月。骨折至手术的时间为3至18天。15例患者在7天内接受手术，16例患者在7天后接受手术。有4例股骨头坏死。1例患者伴有感染；1例患者发生骨不连，另1例表现为骨合成失败。两组之间的总体并发症发生率无统计学显著差异（p = 0.999）。术前参数或骨折特征均不是并发症的预测因素。与并发症发生相关的唯一因素是前后位（AP）视图中骨折复位不充分（优势比[OR] = 35.50，95%置信区间[CI] = 2.56至548.36，p = 0.008）。