老年股骨颈骨折内固定术后颈短缩的发生率及影响因素

目的探讨老年股骨颈骨折空心钉内固定术后颈短缩的发生率和影响因素，以及其对骨折愈合和髋关节功能的影响。方法 2006年1月至2010年2月间采用闭合复位空心钉内固定治疗175例股骨颈骨折患者，其中110例患者获得随访，男32例，女78例；平均年龄75.3岁；Garden Ⅰ、Ⅱ型骨折42例，GardenⅢ、Ⅳ型骨折68例；平均骨密度T值为-2.8；受伤至手术时间平均为3.6d。记录患者术后12个月髋关节Harris评分，根据随访期间患者X线片表现将患者分为颈短缩组和无颈短缩组，统计颈短缩的发生率，比较两组患者的骨折愈合率和髋关节功能Harris评分。对影响颈短缩的各因素进行Logistic回归分析。 结果 110例患者术后获平均12.5个月（3～ 39个月）随访，共有46例发生颈短缩，发生率为41.8％；骨折愈合104例，愈合率为94.5％；术后12个月髋关节Harris评分平均为72.4分（22 ～ 97分），其中颈短缩组和无颈短缩组随访时间＜10个月的患者分别有8例和11例，未计入Harris评分。颈短缩组髋关节Harris评分平均为（78±17）分，无颈短缩组平均为(86±23)分，两组比较差异有统计学意义（t=-1. 998,P=0.048）；颈短缩组骨折愈合率为95.7％ (44/46)，无颈短缩组为93.8％(60/64)，两组比较差异无统计学意义(x2=3.343,P=0.068)。老年股骨颈骨折行空心钉内固定术后颈短缩的发生与骨密度值、骨折复位质量、骨折类型、患者年龄及性别呈明显相关。 结论空心钉内固定治疗老年股骨颈骨折术后颈短缩的发生率较高，患者的骨密度值、骨折复位质量、骨折类型、年龄及性别是其影响因素，颈短缩会影响术后髋关节的功能，但并不影响骨折愈合。

Incidence of femoral neck shortening after fracture fixation with cancellous screws in the aged patients

ObjectiveTo explore the incidence of femoral neck shortening after fixation with cannulated screws in the aged patients, its influencing factors and effects on fracture healing and hip functional outcome.MethodsFrom January 2006 to February 2010, we treated 175 old patients with femoral neck fractures by cancellous screws fixation. Of them, 110 were successfully followed up. They were 32 men and 78 women, with an average age of 75.3 years. By Garden classification, there were 42 cases of types Ⅰ and Ⅱ and 68 cases of types Ⅲ and Ⅳ. Their mean bone density was - 2. 8. The mean time from injury to surgery was 3.6 days, and the mean weight bearing time was 1.8 months. Incidence of femoral neck shortening was calculated according to the anterior-posterior (AP) radiographs of the fractured hip during the follow-up. The fracture healing rates and the Harris scores at 12 months after surgery were compared between the shortening and non-shortening groups. Multivariate logistic regression analyses were done to explore the influencing factors of femoral neck shortening.ResultsAll the 1 10 patients obtained a mean follow-up of 12. 5 months (from 3 to 39 months) . Femoral neck shortening occurred in 46 cases (41.8％), and fracture healing was achieved in 104 patients (94. 5％ ). The total average Harris score at 12 months after surgery was 72. 4 (from 22 to 97). The average Harris score for the shortening group was 78 ± 17, significantly lower than that for the non-shortening group (86 ± 23) ( t =- 1. 998, P =0. 048). The fracture healing rate was 95.7％ (44/46)for the shortening group, with no significant difference from that for the non-shortening group 93.8％ (60/64)] (x2 =3. 343, P =0. 068). Age, gender, fracture type, reduction quality and bone density were found to be obviously associated with the incidence of femoral neck shortening after internal fixation with cancellous screws.ConclusionsThe incidence of femoral neck shortening after fixation with cannulated screws may be rather high in the aged patients. The age, gender, fracture type, reduction quality and bone density of the patient can be the influencing factors of the shortening. The shortening may have a significant negative impact on hip joint functioning but not on fracture healing.