Department of Orthopedics, Nanjing Medical University, Nanjing, Jiangsu, P.R. China.
Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
J Orthop Surg Res. 2020 Jun 29;15(1):238. doi: 10.1186/s13018-020-01724-4.
To investigate the risk factors for osteonecrosis of the femoral head (ONFH) after the treatment of femoral neck fracture in patients under 60 years old.
A total of 250 cases of femoral neck fracture treated at 3 hospitals in Xuzhou from January 2002 to January 2016 were studied. The patients were followed up for 1~15 years, and the clinical data on femoral head necrosis after the femoral neck operation were analysed retrospectively. Risk factors were recorded, including age, gender, preoperative traction, time from injury to operation, reduction method, type of reduction, BMI, ASA classification, and quality of reduction. Logistic regression analysis was used to evaluate the independent risk factors for ONFH after treatment of femoral neck fracture.
The duration of follow-up was 115 years, with an average of 7.5 years. None of the 250 patients had fracture non-union, but 40 (16%) had necrosis of the femoral head. The time to necrosis of the femoral head was 17 years after the operation, with an average of 3.8 years. Univariate analysis showed that the type of fracture, the quality of reduction, the removal of internal fixation, BMI and ASA classification were risk factors affecting necrosis of the femoral head in patients with femoral neck fracture, and the difference was statistically significant (P < 0.05). Multivariate analysis showed that internal fixation, fracture type (displacement), reduction quality (dissatisfaction), BMI (> 25), and ASA grade (III + IV) were independent risk factors affecting femoral head necrosis in patients with femoral neck fracture.
A variety of high-risk factors for femoral head necrosis are present after surgery with hollow compression screws for femoral neck fracture in adults. Removal of internal fixation, type of fracture, quality of reduction, BMI, and ASA classification were the most important risk factors influencing the development of femoral head necrosis. During treatment, there should be some targeted measures to reduce the incidence of necrosis of the femoral head.
探讨 60 岁以下股骨颈骨折患者治疗后股骨头坏死（ONFH）的危险因素。
回顾性分析 2002 年 1 月至 2016 年 1 月 3 家医院收治的 250 例股骨颈骨折患者的临床资料。患者随访 1~15 年，分析股骨颈手术后股骨头坏死的临床资料。记录年龄、性别、术前牵引、受伤至手术时间、复位方法、复位类型、BMI、ASA 分级、复位质量等可能影响股骨头坏死的危险因素。采用 Logistic 回归分析评估股骨颈骨折治疗后发生 ONFH 的独立危险因素。
本组患者随访时间 115 年，平均 7.5 年。250 例患者均未发生骨折不愈合，但发生股骨头坏死 40 例（16%）。股骨头坏死发生时间为术后 17 年，平均 3.8 年。单因素分析显示，骨折类型、复位质量、内固定取出、BMI、ASA 分级是影响股骨颈骨折患者股骨头坏死的危险因素，差异有统计学意义（P<0.05）。多因素分析显示，内固定、骨折类型（移位）、复位质量（不满意）、BMI（>25）、ASA 分级（III+IV）是影响股骨颈骨折患者股骨头坏死的独立危险因素。
成人空心加压螺钉治疗股骨颈骨折后存在多种股骨头坏死的高危因素，内固定取出、骨折类型、复位质量、BMI、ASA 分级是影响股骨头坏死发生的最重要的危险因素。治疗过程中应采取一些针对性措施，降低股骨头坏死的发生率。
