Chen Mang-Mang, Lyu Yang-Xun, Lin Sheng-Lei, Huang Li-Peng, Dong Qi-Rong
Wenzhou Central Hospital, Wenzhou 325000, Zhejiang, China.
Zhongguo Gu Shang. 2021 Mar 25;34(3):203-8. doi: 10.12200/j.issn.1003-0034.2021.03.003.
To investigate the related factors of aseptic necrosis of femoral head after closed reduction and internal fixation of femoral neck fracture.
From January 2009 to January 2016, 236 patients with femoral neck fracture were treated with closed reduction and internal fixation with 3 hollow lag screws, including 111 males and 125 females, aged from 19 to 89 (50.17±12.88) years. According to the follow-up results, the correlation of aseptic necrosis of femoral head was analyzed. Univariate analysis of age, gender, injured side, body weight, injury mechanism, preoperative waiting time, Garden classification and whether there was comminution of femoral neck cortex was conducted to obtain the independent variables with significant difference. Then binary logistic regression analysis was conducted to explore the independent risk factors of avascular necrosis of femoral head.
The average follow-up period of 236 cases was 4.58 years. There were significant differences in the range of injury (24.69% vs. 5.16%, =19.405, =0.000), operation waiting time>48 hours (20.00% vs. 6.38%, =10.065, =0.002), Garden type Ⅲ/Ⅳ (18.52% vs. 2.97%, =13.357, =0.000), femoral neck cortex comminution (66.67% vs. 4.88%, =39.968, =0.000). Multivariate logistic regression analysis showed that:injury mechanism [high energy injury, Exp (B)=4.397, 95%CI=(1.672-11.562), =0.003], preoperative waiting time >48 h [Exp (B)= 3.060, 95%CI=(1.176-7.966), =0.022], comminution of femoral neck cortex [comminution of femoral neck pressure side cortex, Exp (B)=3.944, 95%CI=(1.245-12.494), =0.020;comminution of femoral neck pressure side and tension side cortex, Exp(B)= 23.761, 95%CI=(3.805-148.374), =0.001) were independent risk factors for avascular necrosis after internal fixation of femoral neck fracture. Garden type Ⅲ/Ⅳ was not an independent risk factor in this study [Exp (B) = 1.985, 95%CI=(0.436-9.032), =0.375].
High energy injury, preoperative waiting time (>48 h) and comminution of femoral neck cortex were independent risk factors for aseptic necrosis of femoral head. In addition, cortical comminution on the pressure side and tension side of the femoral neck is a strong prognostic risk factor for aseptic necrosis of the femoral head, because it indicates a more serious and complex injury mechanism.
探讨股骨颈骨折闭合复位内固定术后股骨头无菌性坏死的相关因素。
2009年1月至2016年1月，236例股骨颈骨折患者采用3枚空心拉力螺钉进行闭合复位内固定治疗，其中男性111例，女性125例，年龄19～89岁，平均（50.17±12.88）岁。根据随访结果，分析股骨头无菌性坏死的相关性。对年龄、性别、伤侧、体重、损伤机制、术前等待时间、Garden分型及股骨颈皮质是否粉碎进行单因素分析，得出有显著差异的自变量。然后进行二元logistic回归分析，探讨股骨头缺血性坏死的独立危险因素。
236例患者平均随访4.58年。损伤范围（24.69%对5.16%，χ²=19.405，P=0.000）、手术等待时间>48小时（20.00%对6.38%，χ²=10.065，P=0.002）、GardenⅢ/Ⅳ型（18.52%对2.97%，χ²=13.357，P=0.000）、股骨颈皮质粉碎（66.67%对4.88%，χ²=39.968，P=0.000）差异有统计学意义。多因素logistic回归分析显示：损伤机制[高能损伤，Exp（B）=4.397，95%CI=（1.672～11.562），P=0.003]、术前等待时间>48小时[Exp（B）=3.060，95%CI=（1.176～7.966），P=0.022]、股骨颈皮质粉碎[股骨颈压力侧皮质粉碎，Exp（B）=3.944，95%CI=（1.245～12.494），P=0.020；股骨颈压力侧和张力侧皮质粉碎，Exp（B）=23.761，95%CI=（3.805～148.374），P=0.001]是股骨颈骨折内固定术后缺血性坏死的独立危险因素。GardenⅢ/Ⅳ型在本研究中不是独立危险因素[Exp（B）=1.985，95%CI=（0.436～9.032），P=0.375]。
高能损伤、术前等待时间（>48小时）和股骨颈皮质粉碎是股骨头无菌性坏死的独立危险因素。此外，股骨颈压力侧和张力侧皮质粉碎是股骨头无菌性坏死的强烈预后危险因素，因为它表明损伤机制更严重和复杂。
