摘要
目的探讨动力髋螺钉（DHS）联合防旋钉内固定治疗股骨颈骨折术后股骨头坏死的影响因素。方法采用回顾性病例系列研究分析2010年5月—2015年5月收治的106例应用DHS联合防旋钉内固定治疗的股骨颈骨折患者临床资料，其中男59例，女47例；年龄27～76岁，平均57．0岁。GardenⅡ型27例，Ⅲ型51例，Ⅳ型28例。根据末次随访时影像学表现，将患者分为股骨头坏死组（18例）和未坏死组（88例）。统计两组性别、年龄、Garden分型、Pauwels分型、Singh指数、受伤至手术时间、复位方式、复位质量、术后完全负重时间、内固定是否取出及内固定取出术的手术耗时等因素，利用多因素Logistic回归分析影响股骨颈骨折DHS联合防旋钉内固定术后股骨头坏死的危险因素。结果随访时间26～76个月，平均49个月。共18例发生股骨头坏死，发生率为17．0％。单因素分析显示，Garden分型、复位质量、内固定是否取出及内固定取出术的手术耗时（P〈0．01）为术后股骨头缺血性坏死的影响因素。多因素Logistic回归分析显示，高等级Garden分型（95％CI 0．008，0．998，P〈0．05）、内固定取出及不顺利的内固定取出术（95％CI0．000，0．143，P〈0．01）与术后发生股骨头缺血性坏死显著相关。结论骨折移位、内固定取出及扩大钉道等可能破坏股骨头血供的因素将提高股骨头坏死率，因此股骨颈骨折DHS联合防旋钉内固定术后内固定取出需慎重，尤其当防旋空心钉取出困难时建议予以保留，不要强行取出。
Objective To explore the influence factors for femoral head necrosis after treatment of femoral neck fractures with dynamic hip screw （DHS） and anti-rotation screw. Methods A retrospective case series analysis was made on the clinical data of 106 cases of femoral neck fractures who had undergone fixation with DHS and anti-rotation screw between May 2010 and May 2015. There were 59 males and 47 females, with an average age of 57.0 years （range, 27-76 years）. By Garden classification, there were 27 cases of type II , 51 cases of type m and 28 cases of type IV. All cases were divided into femoral head necrosis group （18 cases）, and none-necrosis group （88 cases） according to the radiographs of the fractured hip at the follow-up. Univariate analyses and a multivariate logistic regression analysis were made to test whether the following factors were significantly associated with femoral neck necrosis：sex, age, Garden classification, Pauwels classification, Singh index, injury-to-surgery time interval, reduction methods, reduction quality, complete weight-bearing time, implant removal and the time cost of implant removal surgery. Results All the 106 patients obtained a mean follow-up of 49 months （range, 26-76 months）. Femoral head necrosis occurred in 18 cases （17.0%）. In univariate analyses, Garden classification, reduction quality, implant removal and long time of the implant removal surgery were significantly associated with femoral head necrosis （ P 〈 0.01 ）. In multivariate logistic regression analysis, high level of Garden classification（95% CI 0. 008, 0. 998, P 〈 0.05 ） , implant removal and long time of the implant removal surgery （95% CI O. 000, 0. 143, P 〈 0.01 ） were found to have a significant effect on femoral head necrosis development. Conclusions Fracture displacement, removal of internal fixation and broadening the screw canal, which eand hinder the blood supply of femoral head, will enhance the rate of femoral head necrosis. As a result, it needs prudent consideration to remove internal fixation after internal fixation with DHS combined with anti-rotation screw for femoral neck fractures. When it is difficult to remove the anti-rotation screw, it is better to give up, rather than to force a removal.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2017年第9期801-807,共7页
Chinese Journal of Trauma
基金
杭州市卫生计生科技计划项目（2016B62）
关键词
股骨头坏死
股骨颈骨折
骨折固定术
内
骨钉
Femoral neck necrosis
Femoral neck fractures
Fracture fixation, internal
Bone nails
