孤立性股骨颈骨折与同侧股骨颈及股骨干骨折的股骨颈并发症
Femoral Neck Complications in Isolated Femoral Neck Fractures Versus Ipsilateral Femoral Neck and Shaft Fractures.
作者信息
Hreha Jeremy, Large Thomas M, Batko Brian, Bonsu Janice M, Savani Ujjawal, Fraser Helyn, Wild Emily, Mendiratta Dhruv, Adams Mark R
机构信息
From the Department of Orthopaedic Surgery, Lehigh Valley Health Network, Lehigh, PA (Dr. Hreha); the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Dr. Large, Dr. Bonsu, and Mr. Savani); the Uhs Wilson Medical Center, Johnson City, TN (Dr. Batko); the Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD (Dr. Fraser); the Department of Orthopaedic Surgery, Saint Louis University, St. Louis, MO (Dr. Wild); and the Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ (Dr. Mendiratta and Dr. Adams).
出版信息
J Am Acad Orthop Surg Glob Res Rev. 2025 Aug 27;9(9). doi: 10.5435/JAAOSGlobal-D-25-00224. eCollection 2025 Sep 1.
OBJECTIVES
There are limited data on the difference in outcomes between patients with isolated femoral neck fractures (IsoFN) and those with a femoral neck and ipsilateral femoral shaft fracture (IpsiFNS) in terms of osteonecrosis, nonunion, and revision surgery rates. We hypothesized that displaced IsoFN fractures would have higher rates of femoral neck nonunion, osteonecrosis, and hip revision surgery than displaced IpsiFNS fractures. Comparisons were made to determine the relationship between these outcomes and other variables.
METHODS
A retrospective review of patients age 18 to 55 years from 2005 to 2020 at two level-I trauma academic institutions was performed, identifying 107 patients in total (IpsiFNS 51, IsoFN 56). The review analyzed the rates of displacement, osteonecrosis, nonunion, and revision surgery. Further comparisons were made to determine the effect of reduction quality, fixation method, and reduction type on these outcomes.
RESULTS
Patients with displaced IsoFN had a significantly higher nonunion, revision surgery and osteonecrosis rate (38.5%, 38.5%, 17.3%) than in patients with IpsiFNS (6.7%, 13.3%, 0%; P = 0.004, P = 0.010, P = 0.016 respectively). There was a relationship between nonunion and femoral neck fixation with fully threaded screws (P = 0.036 and P = 0.004). Among patients who underwent an open reduction, nonunion rates were significantly higher for displaced IsoFN than for displaced IpsiFNS (7.4% vs. 43.2%, P = 0.008). Osteonecrosis rates had a relationship with reduction quality (P = 0.044).
CONCLUSIONS
Patients with a displaced isolated femoral neck fractures are at higher risk for nonunion, osteonecrosis, and revision surgery than those with a displaced femoral neck fracture associated with an IpsiFNS. Quality of reduction had a relationship with osteonecrosis rates. An open approach to the neck reduction was associated with nonunion at a higher rate in displaced IsoFN than in displaced IpsiFNS. A fixation construct of multiple cancellous independent screws that included fully threaded screws had higher odds for nonunion.
目的
关于单纯股骨颈骨折（IsoFN）患者与股骨颈合并同侧股骨干骨折（IpsiFNS）患者在骨坏死、骨不连和翻修手术率方面的预后差异，相关数据有限。我们推测，移位的IsoFN骨折比移位的IpsiFNS骨折具有更高的股骨颈骨不连、骨坏死和髋关节翻修手术发生率。进行比较以确定这些预后与其他变量之间的关系。
方法
对2005年至2020年期间两家一级创伤学术机构中年龄在18至55岁的患者进行回顾性研究，共纳入107例患者（IpsiFNS 51例，IsoFN 56例）。该研究分析了移位、骨坏死、骨不连和翻修手术的发生率。进一步比较以确定复位质量、固定方法和复位类型对这些预后的影响。
结果
移位的IsoFN患者的骨不连、翻修手术和骨坏死发生率（分别为38.5%、38.5%、17.3%）显著高于IpsiFNS患者（分别为6.7%、13.3%、0%；P = 0.004、P = 0.010、P = 0.016）。骨不连与使用全螺纹螺钉进行股骨颈固定之间存在关联（P = 0.036和P = 0.004）。在接受切开复位的患者中，移位的IsoFN的骨不连发生率显著高于移位的IpsiFNS（7.4%对43.2%，P = 0.008）。骨坏死发生率与复位质量有关（P = 0.044）。
结论
与伴有IpsiFNS的移位股骨颈骨折患者相比，移位的单纯股骨颈骨折患者发生骨不连、骨坏死和翻修手术的风险更高。复位质量与骨坏死发生率有关。对于移位的IsoFN，切开复位的方法比移位的IpsiFNS具有更高的骨不连发生率。包含全螺纹螺钉的多个松质骨独立螺钉固定结构发生骨不连的几率更高。
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