Zhang Chi, Zhu Xiaoxiao, Pei Genwang, Xu Ping, Zeng Xianshang, Zhang Lili, Zhang Nan, Zeng Dan, Cao Lei, Yu Weiguang, Zhang Xinchao
The first clinical college of Jinan University, Huangpu Avenue West No.613, Tianhe District, Guangzhou, 510630, China.
Department of joint surgery, The Third Affiliated Hospital of Guangzhou Medical University, Duobao Road No.63, Liwan District, Guangzhou, Guangdong, 510150, China.
BMC Musculoskelet Disord. 2017 Nov 10;18(1):440. doi: 10.1186/s12891-017-1804-x.
Avascular necrosis of the femoral head (AVNFH) occurs infrequently following femoral neck fracture. The association between AVNFH and dyslipidaemia remains controversial. Although major risk factors for AVNFH have been proposed, most of them remain under discussion. Our purpose herein was to evaluate the association between dyslipidaemia and AVNFH following low-energy femoral neck fractures treated with cancellous screws in elderly patients in our tertiary care centre.
Four hundred and seventy-two consecutive patients (472 hips) with low-energy femoral neck fractures were identified and treated with cancellous screws from July 2007 to April 2013. Patients underwent evaluations preoperatively and each subsequent postoperative visit (months 1, 6, 12, 18, 24, 30, and 36). Clinical and radiographic evaluations were documented at each visit. The risk factors of AVNFH were assessed by multivariate binary logistic analysis.
Follow-up was available for 277 patients, which included 135 patients diagnosed with AVNFH (AVNFH group) and 142 patients without AVNFH (control group). The median follow-up for patients alive at the time of analysis was 40 months (range, 37 to 46 months). The mean total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), and apolipoprotein B (Apo-B) values were considerably higher in the AVNFH group compared with those in the control group. The mean high density lipoprotein cholesterol (HDL-C) and apolipoprotein A1(Apo-A1) values were significantly lower in the AVNFH group compared with those in the control group. A multivariate logistic backward regression model showed that HDL-C and LDL-C were the only variables associated with the development of postoperative AVNFH in patients with a femoral neck fracture (Odds ratio[OR] 33.09, 95% Confidence Interval[CI]: 2.65-19.42, p < 0.001 and OR 45.94, 95% CI: 0.47-27.75, p < 0.001, respectively).
Our results suggest that both low HDL-C and high LDL-C have a tendency to result in the occurrence of AVNFH in elderly patients with low-energy femoral neck fractures treated with cancellous screws.
股骨头缺血性坏死（AVNFH）在股骨颈骨折后较少见。AVNFH与血脂异常之间的关联仍存在争议。尽管已提出AVNFH的主要危险因素，但其中大多数仍在讨论中。我们的目的是评估在我们的三级医疗中心接受松质骨螺钉治疗的老年患者中，血脂异常与低能量股骨颈骨折后AVNFH之间的关联。
确定了2007年7月至2013年4月期间连续472例（472髋）低能量股骨颈骨折患者，并采用松质骨螺钉进行治疗。患者在术前及术后每次随访（第1、6、12、18、24、30和36个月）时接受评估。每次随访时记录临床和影像学评估结果。通过多变量二元逻辑分析评估AVNFH的危险因素。
对277例患者进行了随访，其中包括135例诊断为AVNFH的患者（AVNFH组）和142例未发生AVNFH的患者（对照组）。在分析时仍存活的患者的中位随访时间为40个月（范围37至46个月）。与对照组相比，AVNFH组的总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）和载脂蛋白B（Apo-B）的平均水平显著更高。与对照组相比，AVNFH组的高密度脂蛋白胆固醇（HDL-C）和载脂蛋白A1（Apo-A1）的平均水平显著更低。多变量逻辑向后回归模型显示，HDL-C和LDL-C是股骨颈骨折患者术后发生AVNFH的唯一相关变量（比值比[OR]分别为33.09，95%置信区间[CI]：2.65 - 19.42，p < 0.001；OR为45.94，95%CI：0.47 - 27.75，p < 0.001）。
我们的结果表明，低HDL-C和高LDL-C均有导致接受松质骨螺钉治疗的老年低能量股骨颈骨折患者发生AVNFH的倾向。
