中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2012年
6期
477-479
,共3页
孙欣%曾荣%胡资兵%郭伟韬%陈思圆%王斌%陈俊虎
孫訢%曾榮%鬍資兵%郭偉韜%陳思圓%王斌%陳俊虎
손흔%증영%호자병%곽위도%진사원%왕빈%진준호
股骨颈骨折%骨折固定术,内%骨钉%股骨头坏死
股骨頸骨摺%骨摺固定術,內%骨釘%股骨頭壞死
고골경골절%골절고정술,내%골정%고골두배사
Femoral head fracture%Fracture fixation,internal%Bone nail%Femoral head necrosis
目的 探讨空心螺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 对于2000年1月至2008年9月收治且获得随访的172例新鲜股骨颈骨折采用加压空心螺钉内固定治疗骨折一期获得愈合的患者进行回顾性分析,男107例,女65例;年龄13 ~55岁,平均38.5岁;骨折按照Garden分型:Ⅰ型6例,Ⅱ型40例,Ⅲ型90例,Ⅳ型36例.受伤至手术时间平均为8.3d.根据随访期间患者影像学表现将患者分为股骨头坏死组与股骨头无坏死组,统计股骨头坏死的发生率,并对影响股骨头坏死的各项因素进行logistic回归分析. 结果 172例患者术后获平均54个月(30 ~ 86个月)随访,共有14例发生股骨头坏死,发生率为8.1%;术后48个月髋关节Harris评分平均为85.9分(57~99分).股骨头坏死发生与取出内固定、骨折分型(Ⅲ、Ⅳ型)、年龄、性别(女性)及术后负重时间(>2个月)显著相关,其中与取出内固定最为相关(P=0.002). 结论 股骨颈骨折愈合后,加压空心螺钉取出可能对股骨头血运产生不利影响,加压空心螺钉取出是股骨头坏死的主要诱发因素.
目的 探討空心螺釘內固定治療股骨頸骨摺術後股骨頭壞死的影響因素. 方法 對于2000年1月至2008年9月收治且穫得隨訪的172例新鮮股骨頸骨摺採用加壓空心螺釘內固定治療骨摺一期穫得愈閤的患者進行迴顧性分析,男107例,女65例;年齡13 ~55歲,平均38.5歲;骨摺按照Garden分型:Ⅰ型6例,Ⅱ型40例,Ⅲ型90例,Ⅳ型36例.受傷至手術時間平均為8.3d.根據隨訪期間患者影像學錶現將患者分為股骨頭壞死組與股骨頭無壞死組,統計股骨頭壞死的髮生率,併對影響股骨頭壞死的各項因素進行logistic迴歸分析. 結果 172例患者術後穫平均54箇月(30 ~ 86箇月)隨訪,共有14例髮生股骨頭壞死,髮生率為8.1%;術後48箇月髖關節Harris評分平均為85.9分(57~99分).股骨頭壞死髮生與取齣內固定、骨摺分型(Ⅲ、Ⅳ型)、年齡、性彆(女性)及術後負重時間(>2箇月)顯著相關,其中與取齣內固定最為相關(P=0.002). 結論 股骨頸骨摺愈閤後,加壓空心螺釘取齣可能對股骨頭血運產生不利影響,加壓空心螺釘取齣是股骨頭壞死的主要誘髮因素.
목적 탐토공심라정내고정치료고골경골절술후고골두배사적영향인소. 방법 대우2000년1월지2008년9월수치차획득수방적172례신선고골경골절채용가압공심라정내고정치료골절일기획득유합적환자진행회고성분석,남107례,녀65례;년령13 ~55세,평균38.5세;골절안조Garden분형:Ⅰ형6례,Ⅱ형40례,Ⅲ형90례,Ⅳ형36례.수상지수술시간평균위8.3d.근거수방기간환자영상학표현장환자분위고골두배사조여고골두무배사조,통계고골두배사적발생솔,병대영향고골두배사적각항인소진행logistic회귀분석. 결과 172례환자술후획평균54개월(30 ~ 86개월)수방,공유14례발생고골두배사,발생솔위8.1%;술후48개월관관절Harris평분평균위85.9분(57~99분).고골두배사발생여취출내고정、골절분형(Ⅲ、Ⅳ형)、년령、성별(녀성)급술후부중시간(>2개월)현저상관,기중여취출내고정최위상관(P=0.002). 결론 고골경골절유합후,가압공심라정취출가능대고골두혈운산생불리영향,가압공심라정취출시고골두배사적주요유발인소.
Objective To explore the influencing factors of femoral head necrosis after treatment of femoral neck fractures with compressive hollow screws.Methods From January 2000 to September 2008,we treated 172 patients with femoral neck fracture by fixation with compressive hollow screws.They were 107 men and 65 women,with an average age of 38.5 years (from 13 to 55 years).By Garden classification,there were 6 cases of type Ⅰ,40 cases of type Ⅱ,90 cases of type Ⅲ and 36 cases of type Ⅳ.The time from injury to surgery averaged 8.3 days.Incidence of femoral head necrosis was calculated according to the radiographs of the fractured hip at the follow-up.The Harris scores at 48 months after surgery were compared between the necrosis and non-necrosis groups.Multivariate logistic regression analyses were conducted to explore the influencing factors of femoral head necrosis.Results All the 172 patients obtained a mean follow-up of 54 months (from 30 to 86 months).Femoral head necrosis occurred in 14 cases (8.1% ).The total average Harris score for this series was 85.9 points (from 57 to 99 points).Screw removal,fracture type,bone density,gender and postoperative weight-bearing time were found to be significantly associated with the incidence of femoral head necrosis.The screw removal was the most closely associated with the necrosis ( P =0.002).Conclusion After treatment of femoral neck fractures with compressive hollow screws,it should be prudent to remove the compressive hollow screws,because they may have a negative impact on the blood supply in the femoral head and induce femoral head necrosis.