代谢综合征对股骨颈骨折空心螺钉内固定术预后的影响

目的:探讨代谢综合征对股骨颈骨折空心螺钉内固定术预后的影响。方法:回顾性分析2013年1月至2016年4月接受空心螺钉内固定术治疗的93例股骨颈骨折患者的病例资料,其中合并代谢综合征者34例(代谢综合征组)、无代谢综合征者59例(无代谢综合征组)。术后观察骨折愈合情况,采用疼痛视觉模拟量表(visual analogue scale,VAS)评价髋部疼痛程度,采用Harris髋关节功能评分标准评价髋关节运动功能,根据髋关节MRI检查结果评价股骨头坏死情况,采用Mose圆心法计算股骨颈短缩长度(股骨颈短缩长度≤5 mm为无短缩、>5 mm为短缩)。结果:①骨折愈合情况。代谢综合征组6例骨折不愈合,无代谢综合征组5例骨折不愈合,2组骨折不愈合发生率的差异无统计学意义(χ^2=1.740,P=0.187);骨折不愈合者均拆除空心螺钉,行全髋关节置换术(total hip arthroplasty,THA)。②髋部疼痛及髋关节运动功能。排除骨折不愈合者,术后36个月,代谢综合征组的髋部疼痛VAS评分高于无代谢综合征组(2.94±1.81)分,(2.11±1.43)分,t=2.356,P=0.021]、Harris髋关节功能评分低于无代谢综合征组(84.18±5.34)分,(88.39±5.78)分,t=3.257,P=0.002]。③股骨头坏死。排除骨折不愈合者,术后36个月,代谢综合征组9例出现股骨头坏死,无代谢综合征组7例出现股骨头坏死,代谢综合征组股骨头坏死的发生率高于无代谢综合征组(χ^2=4.319,P=0.038);股骨头坏死患者后期均采用THA治疗。④股骨颈短缩。排除骨折不愈合者,术后36个月,代谢综合征组股骨颈短缩长度≤5 mm者7例、6~10 mm者12例、≥11 mm者9例,无代谢综合征组股骨颈短缩长度≤5 mm者27例、6~10 mm者16例、≥11 mm者11例,无代谢综合征组股骨颈短缩情况优于代谢综合征组(Z=-2.039,P=0.041);代谢综合征组股骨颈短缩的发生率高于无代谢综合征组(χ^2=4.748,P=0.029)。结论:代谢综合征可影响股骨颈骨折空心螺钉内固定患者的手术预后,术后髋部疼痛及功能障碍较为明显,骨折愈合后股骨头坏死及股骨颈短缩的发生率均较高,且股骨颈短缩程度相对严重。

Effects of metabolic syndrome on prognosis of patients who received surgery of hollow screw internal fixation for femoral neck fractures

Objective:To explore the effects of metabolic syndrome(MS)on prognosis of patients who received surgery of hollow screw internal fixation for femoral neck fractures.Methods:The medical records of 93 patients with femoral neck fractures who received surgery of hollow screw internal fixation from January 2013 to April 2016 were analyzed retrospectively,in which 34 patients had MS(MS group)and 59 patients had no MS(non-MS group).The fracture healing was observed after the surgery.The hip pain degree and hip motor function were evaluated by using pain visual analogue scale(VAS)scores and Harris hip scores respectively.The femur head necrosis was evaluated according to the results of MRI examination of hip,and the femoral neck shortening length was calculated by using Mose circle center method.The femoral neck shortening length of≤5 mm was judged as non-shortening while that of>5 mm was judged as shortening.Results:The nonunion of fracture was found in 6 patients in MS group and 5 patients in non-MS group,and there was no statistical difference in the incidence rate of nonunion of fracture between the 2 groups(χ^2=1.740,P=0.187).The hollow screws were removed and the total hip arthroplasty(THA)was performed on the patients with nonunion of fracture.At 36 months after the surgery,the hip pain VAS scores were higher and the Harris hip scores were lower in MS group compared to non-MS group except the patients with nonunion of fracture(2.94+/-1.81 vs 2.11+/-1.43 points,t=2.356,P=0.021;84.18+/-5.34 vs 88.39+/-5.78 points,t=3.257,P=0.002).The femur head necrosis was found in 9 patients in MS group and 7 patients in non-MS group,and the incidence rate of femur head necrosis was higher in MS group compared to non-MS group(χ^2=4.319,P=0.038).The patients with femur head necrosis were treated with THA in the later period.The femoral neck shortening length was≤5 mm(7),ranged from 6 to 10 mm(12)and≥11 mm(9)in MS group;while the femoral neck shortening length was≤5 mm(27),ranged from 6 to 10 mm(16)and≥11 mm(11)in non-MS group.The femoral neck shortening condition was better in non-MS group compared to MS group(Z=-2.039,P=0.041).The incidence rate of femoral neck shortening was higher in MS group compared to non-MS group(χ^2=4.748,P=0.029).Conclusion:MS can affect the prognosis of femoral neck fractures after hollow screw internal fixation surgery.The patients always present with relatively obvious hip pain and dysfunction and relatively severe femoral neck shortening after the surgery,and the incidence rates of femur head necrosis and femoral neck shortening are relatively high after the fracture healing.