脂类代谢异常对股骨颈骨折患者外科治疗后发生股骨头坏死的诊断效果

目的：探讨脂类代谢异常与股骨颈骨折术后股骨头坏死的关系及脂类代谢异常对其的诊断效果。方法：因股骨颈骨折于我院骨科首次接受外科手术治疗并符合研究纳入、排除标准的232例患者为研究对象，并收集其临床资料，将术后发生股骨头坏死患者（56例）的血脂水平与对照组（176例）进行对比分析；采用 Logistic 回归分析筛选发生股骨头坏死的高危因素，控制其他因素后观察血脂指标的影响大小。结果：股骨颈骨折患者外科治疗后股骨头坏死发生率为24.14%，股骨头坏死患者的总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、载脂蛋白B((Apo-B)水平均明显高于对照组，差异有显著性差异，高密度脂蛋白()、载脂蛋白 A1(Apo-A1)水平均明显低于对照组，差异有显著性差异。血脂指标中总胆固醇和低密度脂蛋白异常为影响股骨颈骨折术后并发生股骨头坏死的独立危险因素，危险度分别为 OR=6.767, OR=6.240。结论：股骨颈骨折外科治疗后发生股骨头坏死与脂质代谢异常密切相关。把脂质代谢水平的指标，尤其是总胆固醇及低密度脂蛋白水平，作为股骨颈骨折术后股骨头坏死的诊断指标之一可能具有一定的临床意义。

The diagnosis effect of abnormal lipid metabolism for the femoral head necrosis after femoral neck fracture operation

Objective To discuss the relationship between abnormal lipid metabolism and the femoral head necrosis after femoral neck fracture operation,and observe the level of abnormal lipid metabolism in patients with femoral neck fracture oc-curs after surgical treatment for the diagnosis effect of femoral head necrosis. Methods Choose the 232 in-patients who were first did the orthopedic surgery in our hospital for femoral neck fracture and meet all criteria to study, and collected their clinical data. Analyze comparatively the blood lipid level of patients with postoperative necrosis of femoral head with the control group;Confirm the risk factors of the postoperative femoral head necrosis, and observe the effects of lipid index after controlling the other factors by Logistic regression. Results The levels of total cholesterol (TC),Triacylglycerol (TG), low density lipoprotein (LDL) and apolipoprotein(Apo) B of the patients with femoral head necrosis were significantly higher than that of control group, while the level of high density lipoprotein(HDL), apolipoprotein (Apo) A1 were significantly lower than the control group.Blood lipid index of total cholesterol and low density lipoprotein are the independent risk factors to the necrosis of the femoral head after operation of femoral neck fracture. Conclusion The femoral head necrosis occurs after surgical treatment of femoral neck frac-ture is closely related to the abnormal lipid metabolism. It is may be clinically significant to put the index of lipid metabolism, especially the total cholesterol and low density lipoprotein levels as one of the diagnosis indicators for the postoperative femoral head necrosis.