CAJ | 학술논문

背景：自加压空心螺纹钉应用于股骨颈骨折修复以来，出现退钉或穿钉的现象并不少见，哪些因素影响加压空心螺纹钉治疗成人股骨颈骨折的稳定性尚无定论。 　　目的：探讨加压空心螺纹钉置入修复成人股骨颈骨折后内固定失效的原因，以提高加压空心螺纹钉治疗成人股骨颈骨折的稳定性。 　　方法：回顾性分析2007年6月至2011年6月行加压空心螺纹钉内固定修复的92例股骨颈骨折患者，根据相关临床资料和随访结果，选取可能影响内固定失效的相关因素如年龄、性别、骨折 Garden 分型、术前骨牵引、手术时机、Garden对线指数、置钉标准、置钉形状、部分负重时间、内固定后并发症等10个危险因素，并对以上因素进行统计、分组及赋值，采用单因素χ2分析剔除无关因素后进行多因素Logistic回归分析。 　　结果与结论：92例患者获18-72个月随访。末次随访时，根据Harris评定标准评价髋关节功能，优28例，良25例，可17例，差22例，优良率为58%。影像学结果显示，根据骨折是否移位将Garden分型分为两组，GardenⅠ型22例和GardenⅡ型29例为无移位组，GardenⅢ型25例和GardenⅣ型16例为移位组，其内固定失效率分别为12%和39%；Garden对线指数正常组和异常组内固定失效率分别为16%和59%；置钉标准达标组和未达标组内固定失效率分别为19%和70%；内固定后无并发症与内固定后有并发症组内固定失效率分别为14%和55%。以上因素组间差异有显著性意义(P <0.05)。选取有统计学意义的因素进行多因素Logistic回归分析，结果表明，骨折Garden分型、Garden对线指数、置钉标准和内固定后并发症为加压空心螺纹钉置入修复成人股骨颈骨折后内固定失效(退钉或穿钉)的危险因素。
배경：자가압공심라문정응용우고골경골절수복이래，출현퇴정혹천정적현상병불소견，나사인소영향가압공심라문정치료성인고골경골절적은정성상무정론。 　　목적：탐토가압공심라문정치입수복성인고골경골절후내고정실효적원인，이제고가압공심라문정치료성인고골경골절적은정성。 　　방법：회고성분석2007년6월지2011년6월행가압공심라문정내고정수복적92례고골경골절환자，근거상관림상자료화수방결과，선취가능영향내고정실효적상관인소여년령、성별、골절 Garden 분형、술전골견인、수술시궤、Garden대선지수、치정표준、치정형상、부분부중시간、내고정후병발증등10개위험인소，병대이상인소진행통계、분조급부치，채용단인소χ2분석척제무관인소후진행다인소Logistic회귀분석。 　　결과여결론：92례환자획18-72개월수방。말차수방시，근거Harris평정표준평개관관절공능，우28례，량25례，가17례，차22례，우량솔위58%。영상학결과현시，근거골절시부이위장Garden분형분위량조，GardenⅠ형22례화GardenⅡ형29례위무이위조，GardenⅢ형25례화GardenⅣ형16례위이위조，기내고정실효솔분별위12%화39%；Garden대선지수정상조화이상조내고정실효솔분별위16%화59%；치정표준체표조화미체표조내고정실효솔분별위19%화70%；내고정후무병발증여내고정후유병발증조내고정실효솔분별위14%화55%。이상인소조간차이유현저성의의(P <0.05)。선취유통계학의의적인소진행다인소Logistic회귀분석，결과표명，골절Garden분형、Garden대선지수、치정표준화내고정후병발증위가압공심라문정치입수복성인고골경골절후내고정실효(퇴정혹천정)적위험인소。
BACKGROUND:Since cannulated screw has been applied to femoral neck fracture, it is not uncommon that the screw wear penetrates or refunds. What factors affect the stability of cannulated screw for treatment of femoral neck fractures in adults remains unclear. OBJECTIVE:To explore factors related to internal fixation failure by cannulated screws in treatment of adult femoral neck fracture and improve the stability of the adult femoral neck fracture by cannulated screws. METHODS:A total of 92 adult patients of femoral neck fracture were treated by cannulated screws in our department between June 2007 and June 2011. Their data were retrospectively analyzed. According to clinical information and fol ow-ups, we selected factors such as age, gender, Garden type of fracture, preoperative skeletal traction, timing of surgery, Garden index, standards of pedicle screws, pedicle screw shapes, partial weight bearing time and postoperative complications, which may affect the success rate of cannulated screws for treating femoral neck fracture. The selected factors were then grouped and assigned, after unrelated factors were excluded by one-way χ2 analysis, multiariable Logistic regression analysis was performed. RESULTS AND CONCLUSION:The involved 92 patients were fol owed up for 18-72 months. According to Harris assessment criteria, hip function was excellent in 28 cases, good in 25 cases, fair in 17 cases, and poor in 22 cases at the final fol ow-up, the excellent and good rate was 58%. Radiographic results showed that, the patients were divided into two groups according to the presence of the displacement, GardenⅠ (n=22) and GardenⅡ (n=29) as a group, and Garden Ⅲ (n=25) and Garden Ⅳ (n=16) as the other group, the fixation failure rate was 12%and 39%, respectively. In normol and abnormal Garden Index groups, the fixation failure rate was 16%and 59%, respectively. In nail position standards and non-attainment standards groups, the fixation failure rate was 19%and 70%, respectively. In the complication and non-complication groups, the fixation failure rate was 14%and 55%, respectively. These factor groups showed significant differences (P<0.05). Multiariable Logistic regression analysis showed that, Garden type of fracture, Garden index, standards of pedicle screws, and postoperative complications are the risk factors for internal fixation failure using cannulated screws in treatment of the adult femoral neck fracture.