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中华老年骨科与康复电子杂志 ›› 2019, Vol. 05 ›› Issue (05) : 284 -290. doi: 10.3877/cma.j.issn.2096-0263.2019.05.008

所属专题: 文献

论著

闭合复位空心螺钉治疗股骨颈骨折后股骨头坏死的影响因素分析
王沈栋1, 佘昶1,(), 董启榕1   
  1. 1. 215004 苏州,苏州大学附属第二医院骨科
  • 收稿日期:2019-05-15 出版日期:2019-10-05
  • 通信作者: 佘昶
  • 基金资助:
    江苏省自然科学基金青年基金(BK20160340)

Analysis of influencing factors related to femoral head necrosis after closed reduction and internal fixation with hollow screws

Shendong Wang1, Chang She1,(), Qirong Dong1   

  1. 1. Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
  • Received:2019-05-15 Published:2019-10-05
  • Corresponding author: Chang She
引用本文:

王沈栋, 佘昶, 董启榕. 闭合复位空心螺钉治疗股骨颈骨折后股骨头坏死的影响因素分析[J/OL]. 中华老年骨科与康复电子杂志, 2019, 05(05): 284-290.

Shendong Wang, Chang She, Qirong Dong. Analysis of influencing factors related to femoral head necrosis after closed reduction and internal fixation with hollow screws[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2019, 05(05): 284-290.

目的

回顾性分析闭合复位空心螺钉治疗股骨颈骨折后股骨头坏死的影响因素。

方法

对2009年1月至2017年3月293例采用加压空心螺钉治疗股骨颈骨折的患者进行回顾性分析,其中获得随访的患者247例。应用SPSS20.0软件进行统计学分析,并对影响股骨头坏死的各项因素进行Logistic回归分析。

结果

247例患者获得平均58个月(24~80个月)随访,32例出现股骨头坏死,发生率12.9%,随访时髋关节Harris评分平均81.4±3.9分(54~98分)。影响股骨颈骨折术后股骨头坏死的因素和顺序依次为复位质量(OR=9.854,P=0.012),空心钉排列方式(OR=7.965,P=0.017),骨折分型(OR=6.453,P=0.021),空心钉取出与否(OR=5.364,P=0.027),术前是否牵引(OR=2.561,P=0.042)。

结论

复位质量是影响股骨颈骨折预后最为关键的因素。空心螺钉正三角形排列、空心螺钉取出以及未及时术前牵引均可能加重股骨头坏死。

Objective

To retrospectively study the influencing factors of femoral head necrosis after treatment of femoral neck fractures with closed reduction and internal fixation with compressive hollow screws.

Methods

A total of 247 patients with complete clinical data out of 293 patients with femoral neck fractures treated by closed reduction and internal fixation with compressive hollow screws from January 2009 to March 2017 were included in the study. Multiple correlation factors were analyzed by SPSS 20.0 statistic system. Logistic multiple regression method was used to analyse the influencing factors of femoral head necrosis.

Results

All the 247 patients obtained a mean follow-up of 58 months (24 to 80 months). Femoral head necrosis occurred in 32cases (12.9%). The total average Harris score for this series was 81.4±3.9 points (54 to 98). Factors that might have an impact on necrosis of femoral head were ranked in the following likelihood sequence: quality of reduction (OR=9.854, P=0.012), arrangement of hollow screws (OR=7.965, P=0.017), fracture type (OR=6.453, P=0.021), screw removal or not (OR=5.364, P=0.027), preoperative traction (OR=2.561, P=0.042).

Conclusion

Quality of reduction is the most important factor that influences the prognosis. Triangle configuration of hollow screws, screws removal and no timely traction can increase the incidence of necrosis.

图3 经皮置入3枚定位导针,循导针分别拧入3枚长度合适的中空加压螺钉,透视见内固定位置良好
表1 各因素分组与赋值说明
表2 股骨头坏死组与未发生股骨头坏死组单因素分析结果(例,%)
表3 股骨头坏死Logistic多因素回归分析结果
[1]
Lu HD,Dong YX,Wen XY, et al. Analysis of therapeutic effects of cannulated compression screws for the treatment of femoral neck fractures [J]. Zhongguo Gu Shang, 2011, 24(4): 315-318.
[2]
Gjertsen JE,Vinje T,Engesaeter LB, et al. Internal screw fixation compared with bipolar hemiarthroplasty for treatment of displaced femoral neck fractures in elderly patients [J]. J Bone Joint Surg Am, 2010, 92(3): 619-628.
[3]
Lowe JA,Crist BD,Bhandari M, et al. Optimal treatment of femoral neck fractures according to patient's physiologic age: an Evidence-Based review [J]. Orthopedic Clinics of North America, 2010, 41(2): 157-66.
[4]
Huang HK,Su YP,Chen CM, et al. Displaced femoral neck fractures in young adults treated with closed reduction and internal fixation [J]. Orthopedics, 2010, 33(12): 873.
[5]
Bosch U,Schreiber T,Krettek C. Reduction and fixation of displaced intracapsular fractures of the proximal femur. Clin Orthop Relat Res, 2002, 399: 59-71.
[6]
Garden RS. Malreduction and avascular necrosis in subcapital fractures of the femur [J]. J Bone Joint Surg Br, 1971, 53(2): 183-197.
[7]
Sugano N,Kubo L,Takaoka K, et al. Diagnostic criteria for nontrau matic osteonecrosis of the femoral head. A multicentre study [J]. J Bone Joint Surg Br, 1999, 81(4): 590-595.
[8]
Etienne G,Mont MA,Ragland PS. The diagnosis and treatment of nontraumatic osteonecrosis of the femoral head [J]. Instr Course Lect, 2004, 53: 67-85.
[9]
Beaulé PE,Amstutz HC. Management of ficat stage III and IV osteonecrosis of the hip [J]. J Am Acad Orthop Surg, 2004, 12(2): 96-105.
[10]
赵德伟,胡永成.成人股骨头坏死诊疗标准专家共识(2012年版) [J].中华关节外科杂志:电子版, 2012, 32(3): 479-484.
[11]
Kaushik A,Sankaran B,Varghese M. To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures [J]. Eur J Radiol, 2010, 75(3): 364-375.
[12]
Zlowodzki M,Bhandari M,Keel M, et al. Perception of garden's classification for femoral neck fractures: an international survey of 298 orthopaedic trauma surgeons [J]. Arch Orthop Trauma Surg, 2005, 125(7): 503-505.
[13]
Blundell CM,Parker MJ,Pryor GA, et al. Assessment of the AO classification of intracapsular fractures of the proximal femur [J]. J Bone Joint Surg Br, 1998, 80(4): 679-683.
[14]
Parker MJ,Dynan Y. Is pauwels classification still valid? [J]. Injury, 1998, 29(7): 521-523.
[15]
Bjørgul K,Reikerås O. Outcome of undisplaced and moderately displaced femoral neck fractures [J]. Acta Orthop, 2007, 78(4): 498-504.
[16]
Gašpar D,Crnković T,Durović D, et al. AO group, AO subgroup, Garden and Pauwels classification systems of femoral neck fractures: are they reliable and reproducible? [J]. Med Glas (Zenica), 2012, 9(2): 243-247.
[17]
Schmidt AH,Asnis SE,Haidukewych G, et al. Femoral neck fractures [J]. Instr Course Lect, 2005, 54: 417-445.
[18]
Bhandari M,Tornetta P,Hanson B, et al. Optimal internal fixation for femoral neck fractures: multiple screws or sliding hip screws? [J]. J Orthop Trauma, 2009, 23(6): 403-407.
[19]
Liporace F,Gaines R,Collinge C, et al. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures [J]. J Bone Joint Surg Am, 2008, 90A(8): 1654-1659.
[20]
Parker MJ,Raghavan R,Gurosamy K. Incidence of fracture healing complications after femoral neck fractures [J]. Clin Orthop Relat Res, 2007, 458: 175-179.
[21]
Boraiah S,Paul O,Hammoud S, et al. Predictable healing of femoral neck fractures treated with intraoperative compression and length-stable implants [J]. J Trauma, 2010, 69(1): 142-147.
[22]
Min BW,Kim SJ. Avascular necrosis of the femoral head after osteosynthesis of femoral neck fracture [J]. Orthopedics, 2011, 34(5): 349.
[23]
Vidán MT,Sánchez E,Gracia Y, et al. Causes and effects of surgical delay in patients with hip fracture: a cohort study [J]. Ann Intern Med, 2011, 155(4): 226-233.
[24]
Giannoudis PV,Nikolaou VS,Kheir E, et al. Factors determining quatity of Life and Ievel of sporting activity after internal fixation of all isolated acetabular fracture [J]. J Bone Joint Surg Br, 2009, 91(10): 1354-1359.
[25]
Zlowodzki M,Tornetta P,Haidukewych G, et al. Femoral neck fractures: evidence versus beliefs about predictors of outcome [J]. Orthopedics, 2009, 32(4): 260-267.
[26]
Zdero R,Keast-Butler O. Schemitsch EH. A biomechanical comparison of two triple-screw methods for femoral neck fracture fixation in a synthetic bone model [J]. J Tmuma, 2010, 69(6): 1537-1544.
[27]
Yang JJ,Lin LC,Chao KH, et al. Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration [J]. J Bone Joint Surg Am, 2013, 95(1): 61-69.
[28]
Singh M,Nagrath AR,Maini PS. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis [J]. J Bone Joint Surg Am, 1970, 52(3): 457-467.
[29]
Crowell RR,Edwards WT,Hayes WC. Pullout strength of fixation devices in trabecular bone of the femoral head [Z], Las vegas: Nevada, 1985: 189.
[30]
Benterud JG,Husby T,Graadahl O, et al. Implant holding power of the femoral head [J]. A cadaver study of fracture screws [J]. Acta Orthop Scand, 1992, 63(1): 47-49.
[31]
Wang MN,Guo HS. Fixation for femoral neck fracture based on nonlinear materials [J]. J Med Biomech, 2012, 27(2): 152-158.
[32]
Yao SQ,Zhang YZ,Zhang FQ, et al. Research of the effect of drawing out the screws intermittently on the healing of femoral neck fracture [J]. Orthop J Chin, 2005, 13: 915-917.
[33]
Sun X,Zeng R,Hu ZB, et al. Femoral head necrosis after treatment of femoral neck fractures with compressive hollow screws [J]. Chin J Orthop Trauma, 2012(14): 477-479.
[34]
Kalhor M,Beck M,Huff TW, et al. Capsular and pericapsular contributions to acetabular and femoral head perfusion [J]. J Bone Joint Surg Am, 2009, 91(2): 409-418.
[35]
Thanakit V,Thinley U,Witoonchart K, et al. Incidence of osteonecrosis from histopathological study following fracture neck of femur [J]. J Med Assoc Thai, 2009, 92(6): 842-847.
[36]
Rödén M,Schön M,Fredin H. Treatment of displaced femoral neck fractures: a randomized minimum 5-year follow-up study of screws and bipolar hemiprostheses in 100 patients [J]. Acta Orthop Scand, 2003, 74(1): 42-44.
[37]
Strange-Vognsen HH,Bagger J,Lind T, et al. The influence of skeletal traction on intraarticular pressure of the hip [J]. Acta Orthop Belg, 1991, 57(3): 272-273.
[38]
Finsen V,Børset M,Buvik GE, et al. Preoperative traction in patients with hip fractures [J]. Injury, 1992, 23(4): 242-244.
[39]
Needhof M,Radford P,Langstaff R.Preoperative traction for hip fractures in the elderly: A clinical trial [J]. Injury, 1993, 24:317-318.
[40]
Xiao J,Yang XJ,Xiao XS. DSA observation of hemodynamic response of femoral head with femoral neck fracture during traction: a pilot study [J]. J Orthop Trauma, 2012, 26(7): 407-413.
[41]
Bonnaire FA,Weber AT. The influence of haemarthrosis on the development of femoral head necrosis following intracapsular femoral neck fractures [J]. Injury, 2002, 33(Suppl 3): C33-C40.
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