股骨颈骨折空心钉内固定术后长期疗效分析

目的观察股骨颈骨折空心钉内固定术后远期临床疗效及并发症相关影响因素。 方法收集2010年1月至2012年9月103例空心钉内固定治疗的股骨颈骨折病历资料，且均为受伤当时就诊于安徽医科大学第一附属医院骨科的非病理性新鲜闭合骨折。对其中术后5年以上且资料完整的82例进行随访观察。记录患者性别、年龄、致伤暴力、骨折Garden分型、空心钉固定数量、手术方式、骨折复位质量(Garden指数)、下地时间、内固定取出与否、髋关节功能Harris评分及股骨颈不愈合、末期随访时股骨头坏死、股骨颈短缩等情况，应用Logistic回归进行多因素分析。 结果82例患者平均年龄(49±6)岁，平均随访(77±4)个月。31例出现股骨头坏死，坏死率37.8%。其中无症状者占54.84%；11例出现股骨颈不愈合，不愈合率13.41%，且10例行髋关节置换；35例出现股骨颈短缩，短缩率42.68%；末期随访髋关节功能Harris评分优良率71.08%。股骨头坏死相关风险因素分析显示：致伤暴力OR＝0.029, 95%CI (0.003，1.336)，P＝0.005]、骨折Garden分型OR＝18.27, 95%CI (1.547，215.77)，P＝0.021]、手术方式OR＝8.567，95%CI(1.739，42.204)，P＝0.008]、复位质量OR＝0.125，95%CI (0.024, 0.657)，P＝0.014]对其影响显著；而股骨颈不愈合及股骨颈短缩分析结果显示复位质量这一因素影响显著(Wald χ²＝4.471，P＝0.034；Wald χ²＝10.255，P＝0.001)。 结论空心钉内固定治疗股骨颈骨折后长期随访效果基本满意，但远期股骨颈短缩发生率较高，其中复位质量与股骨头坏死、股骨颈不愈合及股骨颈短缩的发生明显相关。

Analysis of effect of five years after internal fixation with cannulated screws in femoral neck fracture

ObjectiveTo investigate the postoperative long-term efficacy and related factors of postoperative complications of femoral neck fracture. MethodsA total of 103 patients of femoral neck fracture fresh and closed were collected from January 2010 to September 2012.Follow-up observation was performed on 82 cases with complete data of more than five years after operation. Gender, age, injury violence, Garden type, the number of cannulated screws, operation method, Garden index, ambulation time, whether to internal fixation removal, Harris score and femoral neck nonunion, femoral head necrosis and shortening of the femoral neck are counted.Logistic regression was used to analyze these factors. ResultsThe mean age of 82 patients was(49±6)years and the average follow-up was (77±4) months. There were 31 cases of femoral head necrosis and necrosis rate was 37.8%. Asymptomatic rate was 54.84% among them. Eleven cases occurred femoral neck nounion in which 10 cases accepted the total hip replacement, and the nounion rate was 13.41%. In 35 cases, the femoral neck was shortened with a short shrinkage of 42.68%. At the end of the follow-up, the good rate of Harris score was 71.08%. Analysis of related risk factors of femoral head necrosis showed that the injury violenceOR=0.029, 95%CI (0.003, 1.336), P=0.005], Garden typeOR=18.27, 95%CI (1.547, 215.77), P=0.021], surgical methodsOR=8.567, 95%CI(1.739, 42.204), P=0.008] and reduction quality OR=0.125, 95%CI (0.024, 0.657), P=0.014] were significant. The results of the nonunion of the femoral neck (Wald χ²=4.471, P=0.034) and the results of the femoral neck shortening (Wald χ²=10.255, P=0.001) showed that the reduction quality was significant influence factor. ConclusionsEfffect of cannulated screw internal fixation treatment of femoral neck fracture after long-term follow-up is satisfaction, but the incidence of shortening of the femoral neck is high.The reduction quality is significantly associated with these three complications.