儿童股骨颈骨折后股骨头缺血性坏死的相关因素分析

目的 探讨儿奄股骨颈骨折后股骨头缺血性坏死的影响因素.方法 回顾1994年6月至2006年4月收治的33例儿童股骨颈骨折患者资料,其中Delbet Ⅰ型1例、Ⅱ型15例、Ⅲ型14例、Ⅳ型2例.平均受伤年龄10.7岁(3.7-14.1岁).所有患儿均随访至骨折愈合后,平均随访时间为3.4年(1.0-12.2年).16例发生股骨头缺血性坏死,其中Ratliff Ⅰ型犁8例、Ⅱ型3例、Ⅲ璎4例、分型不详1例.将受伤年龄、骨折类型、骨折移位程度、复位质量及内固定物类型等影响凶素分别与股骨头缺血性坏死进行计算和统计分析.结果年龄＜10岁组(11例)有4例、年龄≥10岁组(22例)有12例发生股骨头缺血性坏死(P=0.465).骨折Delbet Ⅱ型组(15例)有8例、Ⅲ型组(14例)有6例发生股骨头缺血性坏死,发生率比较差异无统计学意义(P=0.715).无移位骨折组(4例)有1例、移位骨折组(26例)有14例发生股骨头缺血性坏死,发牛率比较差异无统计学意义(P=0.598).复位满意组(20例)有10例、复位不满意组(9例)有6例发生股骨头缺血性坏死,发生率比较差异无统计学意义(P=0.454).非坚强内固定组(27例)有13例、坚强内固定组(4例)有2例发生股骨头缺血性坏死,发牛率比较差异无统计学意义(P=1.000).结论 骨折类型、骨折移位程度、复位质量及受伤年龄等因素均可以影响儿童股骨颈骨折后股骨头缺血性坏死的发牛率.

Analysis of avascular necrosis of the femoral head after pediatric femoral neck fractures

Objecfive To identify what factors contribute to the occurrence of avascular necrosis (AVN) of the femoral head after pediatric femoral neck fractures. Methods A series of 33 pediatric femoral neck fractures who had been admitted to our institution between June 1994 and April 2006 were retrospectively reviewed. There were 1 case of type Ⅰ,15 type Ⅱ,14 type Ⅲ and 2 type IV according to Delbet classification. The mean age at injury was 10.7(3.7 to 14.1) years, and the mean follow-up was 3.4(1 to 12.2)years. All patients were followed up until union was achieved. AVN occurred in 16 cases, including 8 cases of Ratliff type Ⅰ,3 of Ratliff type Ⅱ,4 of Ratliff type Ⅲ and 1 unclassified. Age at injury, fracture type, degree of displacement, quality of reduction and type of fixation were calculated and analyzed with respect to AVN. Results AVN occurred in 4 cases (36.4%)under 10 years old and in 12 cases (54.5%)10 years old or more. Eight cases (53.3%)of AVN occurred in Delbet type Ⅱ and 6 cases (42.9%) of AVN occurred in type Ⅲ.One case (25.0%)of AVN occurred in non-displaced group and 14 cases(53.8%)in displaced group. Ten cases(50.O%)of AVN occurred in the group whose reduction quality was satisfactory and 6 cases(66.7%)in unsatisfactory reduction group. Thirteen cases (48.1%)of AVN occurred in the unstable fixation group and 2 cases (50.0%)in the stable fixation group. Conclusion Fracture type, degree of displacement, quality of reduction and age at injury can affect the occurrence of AVN of the femoral head after pediatric femoral neck fractures.