CAJ | 학술논문

目的：探讨成人股骨颈骨折空心加压螺钉内固定术后股骨头坏死的相关因素，为临床治疗决策提供参考。方法回顾分析2001年1月1日至2010年12月31日期间采用空心加压螺钉内固定手术患者，对年龄、性别、骨折类型（ Garden分型）、手术复位质量（ Garden指数）、受伤至手术时间间隔，复位方式（切开或闭合复位）、术后开始部分负重时间，内固定是否取出8个因素进行统计分析，筛选出差异有统计学意义的因素，然后对各单因素运用logistic多因素回归分析。结果其中有完整随访资料的185例，随访3~10年，平均5.5年，其中28例发生股骨头缺血坏死，坏死率15.14%，影响股骨头坏死的独立因素分别为：骨折类型，骨折复位质量，受伤至手术时间，术后开始部分负重的时间。结论空心加压螺钉治疗股骨颈骨折主要并发症是股骨头缺血性坏死，骨折类型、骨折复位质量、受伤至手术时间、术后开始部分负重的时间是发生股骨头坏死的主要危险因素。其中复位质量、受伤至手术时间、术后开始部分负重的时间是可控的因素，尽早手术复位骨折内固定，提高骨折复位质量，内固定3个月后开始部分负重均能降低股骨头缺血性坏死的发生。现有资料显示，空心加压螺钉内固定治疗股骨颈骨折的总体疗效满意，股骨头坏死率低，手术简单易行，技术要求低，创伤小，对于全身状况良好、预期寿命较长，骨质质量尚好的无移位或轻度移位的老年股骨颈骨折病例，以及年龄较轻的股骨颈骨折患者，建议首选内固定治疗。
목적：탐토성인고골경골절공심가압라정내고정술후고골두배사적상관인소，위림상치료결책제공삼고。방법회고분석2001년1월1일지2010년12월31일기간채용공심가압라정내고정수술환자，대년령、성별、골절류형（ Garden분형）、수술복위질량（ Garden지수）、수상지수술시간간격，복위방식（절개혹폐합복위）、술후개시부분부중시간，내고정시부취출8개인소진행통계분석，사선출차이유통계학의의적인소，연후대각단인소운용logistic다인소회귀분석。결과기중유완정수방자료적185례，수방3~10년，평균5.5년，기중28례발생고골두결혈배사，배사솔15.14%，영향고골두배사적독립인소분별위：골절류형，골절복위질량，수상지수술시간，술후개시부분부중적시간。결론공심가압라정치료고골경골절주요병발증시고골두결혈성배사，골절류형、골절복위질량、수상지수술시간、술후개시부분부중적시간시발생고골두배사적주요위험인소。기중복위질량、수상지수술시간、술후개시부분부중적시간시가공적인소，진조수술복위골절내고정，제고골절복위질량，내고정3개월후개시부분부중균능강저고골두결혈성배사적발생。현유자료현시，공심가압라정내고정치료고골경골절적총체료효만의，고골두배사솔저，수술간단역행，기술요구저，창상소，대우전신상황량호、예기수명교장，골질질량상호적무이위혹경도이위적노년고골경골절병례，이급년령교경적고골경골절환자，건의수선내고정치료。
Objective To explore the related factors femoral head necrosis after the operation on adult femoral neck frac-tures by compressed hollow screws fixation. Methods The author reviewed the patients who were treated by compressed hol-low screws fixation from January 1st,2001 to December 31st,2010 and then made a statistical analysis on the following eight factors:age,gender,fracture type(Garden type),surgical reduction quality(Garden index),the time gap between injury and the operation,reset mode( open reduction or close reduction),the partial weight-bearing time after the operation,whether the fixation is removed. Among these eight factors,the statistically significant factors were selected and then analyzed by logistic re-gression analysis one by one. Results There are 185 cases with a complete set of follow-up data and the follow-up lasts from three to ten years(the average duration is 5. 5 years). Among the 185 cases,28 patients suffered from femoral head ischemic necrosis,which accounts for 15. 14% and the independent factors influencing femoral head necrosis included the following:fracture type,fracture reduction,the time gap between injury and the operation,the partial weight-bearing time after the opera-tion. Conclusion The major complication of femoral neck fractures operation by compressed hollow screws fixation is femoral head ischemic necrosis and the major risk factors are fracture type,fracture reduction,the time gap between injury and the op-eration and the partial weight-bearing time after the operation. Among those factors,reduction quality,the time gap between in-jury and the operation and the partial weight-bearing time after the operation are controlling factors and it is found that femoral head ischemic necrosis can be lowered down when the patient receives compressed hollow screws fixation at an earlier time,im-proves reduction quality and tries to bear partial weight after three months'fixation. The present data shows that compressed hol-low screws fixation is a satisfying treatment of femoral neck fractures as it brings a low rate of femoral head necrosis and the op-eration is easy to carry out since it has a low requirement on technology and produces less trauma. For those senior femoral neck fracture patients who have good body condition,longer life expectancy and no bone displacement or only slight bone dis-placement,or for those young femoral neck fractures patients,compressed hollow screws fixation is their top priority.