Pediatric Orthopedic Surgery Department, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China.
Pediatric Orthopedic Surgery Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Bone Joint J. 2019 Sep;101-B(9):1160-1167. doi: 10.1302/0301-620X.101B9.BJJ-2019-0275.R1.
The aim of this study was to clarify the factors that predict the development of avascular necrosis (AVN) of the femoral head in children with a fracture of the femoral neck.
We retrospectively reviewed 239 children with a mean age of 10.0 years (sd 3.9) who underwent surgical treatment for a femoral neck fracture. Risk factors were recorded, including age, sex, laterality, mechanism of injury, initial displacement, the type of fracture, the time to reduction, and the method and quality of reduction. AVN of the femoral head was assessed on radiographs. Logistic regression analysis was used to evaluate the independent risk factors for AVN. Chi-squared tests and Student's -tests were used for subgroup analyses to determine the risk factors for AVN.
We found that age (p = 0.006) and initial displacement (p = 0.001) were significant independent risk factors. Receiver operating characteristic (ROC) curve analysis indicated that 12 years of age was the cut-off for increasing the rate of AVN. Severe initial displacement (p = 0.021) and poor quality of reduction (p = 0.022) significantly increased the rate of AVN in patients aged 12 years or greater, while in those aged less than 12 years, the rate of AVN significantly increased only with initial displacement (p = 0.048). A poor reduction significantly increased the rate of AVN in patients treated by closed reduction (p = 0.026); screw and plate fixation was preferable to cannulated screw or Kirschner wire (K-wire) fixation for decreasing the rate of AVN in patients treated by open reduction (p = 0.034).
The rate of AVN increases with age, especially in patients aged 12 years or greater, and with the severity of displacement. In patients treated by closed reduction, anatomical reduction helps to decrease the rate of AVN, while in those treated by open reduction, screw and plate fixation was preferable to fixation using cannulated screws or K-wires. Cite this article: 2019;101-B:1160-1167.
本研究旨在阐明哪些因素可预测儿童股骨颈骨折后股骨头发生缺血性坏死（AVN）。
我们回顾性分析了 239 名平均年龄为 10.0 岁（标准差 3.9）的儿童，他们因股骨颈骨折接受了手术治疗。记录了风险因素，包括年龄、性别、侧别、损伤机制、初始移位、骨折类型、复位时间以及复位方法和质量。通过 X 线评估股骨头 AVN。采用 logistic 回归分析评估 AVN 的独立危险因素。采用卡方检验和学生 t 检验进行亚组分析，以确定 AVN 的危险因素。
我们发现年龄（p=0.006）和初始移位（p=0.001）是显著的独立危险因素。受试者工作特征（ROC）曲线分析表明，12 岁是 AVN 发生率增加的临界值。严重的初始移位（p=0.021）和较差的复位质量（p=0.022）显著增加了 12 岁及以上患者的 AVN 发生率，而在 12 岁以下的患者中，仅初始移位（p=0.048）显著增加了 AVN 发生率。不良复位显著增加了闭合复位患者的 AVN 发生率（p=0.026）；与空心螺钉或克氏针（K 钉）固定相比，切开复位患者中使用螺钉和钢板固定更能降低 AVN 发生率（p=0.034）。
AVN 发生率随年龄增长而增加，尤其是 12 岁及以上患者和严重移位患者。在闭合复位患者中，解剖复位有助于降低 AVN 发生率，而在切开复位患者中，螺钉和钢板固定优于使用空心螺钉或 K 钉固定。
引用： 2019;101-B:1160-1167.
