Yin Wenjing, Xu Zhengliang, Sheng Jiagen, Zhang Changqing, Zhu Zhenhong
Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai - China.
Hip Int. 2016 May 16;26(3):215-9. doi: 10.5301/hipint.5000346. Epub 2016 Mar 20.
To evaluate the potential risk factors of the development of femoral head osteonecrosis after healed intertrochanteric fractures.
We retrospectively reviewed all patients who were operated upon with closed reduction and internal fixation for intertrochanteric fractures by our medical group from December 1993 to December 2012. Patients with healed fractures were identified. Age, gender, comorbidities favouring osteonecrosis, causes of injuries, fracture patterns, the location of the primary fracture line, time from injury to surgery, fixation methods, and the development of femur head osteonecrosis of these patients were summarised. Univariate and multivariate logistic regression analysis were performed to evaluate the correlation between potential risk factors and the development of femoral head osteonecrosis.
A total of 916 patients with healed intertrochanteric fractures were identified. Femoral head osteonecrosis was found in 8 cases (0.87%). According to the results of univariate logistic regression, a more proximal fracture line, fixation with dynamic hip screws and age were found to be statistically significant factors. The results of multivariate logistic regression analysis indicated that the statistically significant predictors of femoral head osteonecrosis were younger age (odds ratio [OR] = 17.103; 95% confidence interval [CI], 1.988-147.111), a more proximal fracture line (OR = 31.439; 95% CI, 3.700-267.119) and applying dynamic hip screw as the internal fixation (OR = 11.114; 95% CI, 2.064-59.854).
Regular follow-up is commended in young patients with a proximal fracture line who underwent closed reduction and internal fixation with dynamic hip screw, even though the bone had healed.
评估股骨转子间骨折愈合后发生股骨头坏死的潜在危险因素。
我们回顾性分析了1993年12月至2012年12月间由我们医疗团队进行闭合复位内固定治疗股骨转子间骨折的所有患者。确定骨折已愈合的患者。总结这些患者的年龄、性别、易患骨坏死的合并症、损伤原因、骨折类型、原发骨折线位置、受伤至手术时间、固定方法以及股骨头坏死的发生情况。进行单因素和多因素逻辑回归分析，以评估潜在危险因素与股骨头坏死发生之间的相关性。
共确定916例股骨转子间骨折已愈合的患者。发现8例（0.87%）发生股骨头坏死。根据单因素逻辑回归结果，骨折线位置更高、使用动力髋螺钉固定和年龄是具有统计学意义的因素。多因素逻辑回归分析结果表明，股骨头坏死的统计学显著预测因素为年龄较小（比值比[OR]=17.103；95%置信区间[CI]，1.988 - 147.111）、骨折线位置更高（OR = 31.439；95% CI，3.700 - 267.119）以及使用动力髋螺钉作为内固定（OR = 11.114；95% CI，2.064 - 59.854）。
对于接受闭合复位并用动力髋螺钉内固定治疗且骨折线位置较高的年轻患者，即使骨折已愈合，也建议进行定期随访。
