摘要
目的:探讨年轻患者股骨颈骨折内固定术后发生股骨头坏死的危险因素,描述股骨头存活患者的生活质量,量化其预测因素。方法:选取2013年1月至2016年12月采用闭合复位空心钉内固定手术治疗的股骨颈骨折患者172例(174髋)进行回顾性分析,总结患者的一般资料包括年龄、性别、体重指数、创伤机制、创伤-手术间隔时间、创伤发生季节和内固定物是否取出,影像学资料包括骨折Garden分型、Pauwel分型、股骨头后倾角度、术后骨折复位、螺钉分布情况。进行单因素分析及多因素Logistic回归分析,探讨股骨头坏死及内固定失败的危险因素。对上述内固定术后股骨头存活的患者进行随访,通过SF-36健康调查简表评估患者的生活质量,髋关节功能Harris评分评估患髋关节功能,并通过多重线性回归分析探讨股骨颈骨折术后患者生活质量的预测因素。结果:172例(174髋)患者纳入研究,共29例(16.67%)患者发生股骨头坏死。股骨头坏死多因素Logistic回归分析中有显著差异的变量是复位质量(OR=0.126,P=0.027)和后倾角(OR=4.380,P=0.010)。股骨头存活136例患者(137髋)纳入生活质量调查,Harris评分90.14±7.92,其中优96髋(70.07%),良28髋(20.44%),中13髋(9.49%),差0髋。SF-36评分中生理健康得分为46.12±9.12,心理健康得分为50.21±3.97,两者不呈线性相关(P>0.05),多重线性回归分析中,与生理健康得分相关有显著差异的变量是复位质量与后倾角度,与心理健康得分相关有显著差异的变量是骨折是否移位与创伤机制。结论:复位质量位不佳和后倾角>15°是并发股骨头坏死的危险因素。股骨颈骨折术后患者髋关节功能及心理健康得分恢复良好,但生理健康得分不能恢复到正常人群平均水平,复位质量与后倾角度可作为生理健康得分预测因素,骨折是否移位与创伤机制可作为心理健康得分的预测因素。
Objective:To explore the risk factors of osteonecrosis of femoral head after internal fixation of femoral neck fracture in young patients,to describe the quality of life of patients with surviving femoral head,and to quantify the predictive factors.Methods:From January 2013 to December 2016,172 patients(174 hips)with femoral neck fracture treated by closed reduction and cannulated screw internal fixation were selected for retrospective analysis.The general data of the patients were summarized,including age,gender,body mass index,trauma mechanism,trauma operation interval,trauma season and whether the internal fixation was removed.The imaging data included the Garden classification and Pauwel classification of fractures,femoral head retroversion angle,postoperative fracture reduction,screw distribution.Single factor analysis and multi factor Logistic regression analysis were carried out to explore the risk factors of femoral head necrosis and internal fixation failure.The patients who survived the internal fixation were followed up.The quality of life of the patients was evaluated by the health survey of SF-36.The Harris score of hip joint function was used to evaluate the hip joint function.The predictors of the quality of life of the patients after the operation of femoral neck fracture were analyzed by multiple linear regression analysis.Results:Total 172 patients(174 hips)were included in the study,29 patients(16.67%)had necrosis of the femoral head.In multivariate Logistic regression analysis,the significant differences were reduction quality(OR=0.126,P=0.027)and posterior inclination angle(OR=4.380,P=0.010).One hundred and thirty six patients(137 hips)who survived the femoral head were included in the quality of life survey.Harris score was 90.14±7.92,including excellent 96 hips(70.07%),good 28 hips(20.44%),medium 13 hips(9.49%)and poor 0 hip.In SF-36 score,physical health summary(PCS)was 46.12±9.12,mental health summary(MCS)was 50.21±3.97,there was no linear correlation between them(P>0.05).In multiple linear regression analysis,the variables with significant difference in PCS were reduction quality and retroversion angle,and the variables with significant difference in MCS were fracture displacement and trauma mechanism.Conclusion:Poor reduction quality and posterior inclination angle>15°are the risk factors of femoral head necrosis.The function of hip joint and MCS of patients with femoral neck fracture recovered well,but PCS could not recover to the average level of normal people.The reduction quality and retroversion angle could be used as the predictors of PCS,and the displacement and trauma mechanism of fracture could be used as the predictors of MCS.
作者
刘冠虹
吉万波
刘锦涛
姜宏
LIU Guan-hong;JI Wan-bo;LIU Jin-tao;JIANG Hong(Department of Orthopaedics,Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine,Suzhou 215000,Jiangsu,China)
出处
《中国骨伤》
CAS
CSCD
2020年第8期750-757,共8页
China Journal of Orthopaedics and Traumatology
关键词
股骨颈骨折
股骨头坏死
危险因素
生活质量
Femoral neck fractures
Femur head necrosis
Risk factors
Quality of life
