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Osteonecrosis of femoral head in young patients with femoral neck fracture: a retrospective study of 250 patients followed for average of 7.5 years 年轻病人股骨颈骨折股骨头坏死： 250例平均7.5年回顾研究 翻译：罗殿中 Objective: To investigate the risk factors for osteonecrosis of the femoral head (ONFH) after the treatment of femoral neck fracture in patients under 60 years old. 目的：研究60岁以下股骨颈骨折后股骨头坏死（ONFH）的风险因素 Methods: A total of 250 cases of femoral neck fracture treated at 3 hospitals in Xuzhou from January 2002 to January 2016 were studied. The patients were followed up for 1~15 years, and the clinical data on femoral head necrosis after the femoral neck operation were analysed retrospectively. Risk factors were recorded, including age, gender, preoperative traction, time from injury to operation, reduction method, type of reduction, BMI, ASA classification, and quality of reduction. Logistic regression analysis was used to evaluate the independent risk factors for ONFH after treatment of femoral neck fracture. 方法：自2002年1月至2016年1月徐州市三家医院共治疗250例股骨颈骨折患者，随访1-15年，股骨颈术后股骨头坏死的临床数据通过回顾性研究获取。危险因素包括：年龄、性别、术前牵引、伤后至手术时间、复位方法、是否移位、BMI、ASA分级、复位质量等。对股骨颈骨折后股骨头坏死的独立风险因素进行逻辑回归分析。 Results: The duration of follow-up was 1~15 years, with an average of 7.5 years. None of the 250 patients had fracture non-union, but 40 (16%) had necrosis of the femoral head. The time to necrosis of the femoral head was 1~7 years after the operation, with an average of 3.8 years. Univariate analysis showed that the type of fracture, the quality of reduction, the removal of internal fixation, BMI and ASA classification were risk factors affecting necrosis of the femoral head in patients with femoral neck fracture, and the difference was statistically significant (P < 0.05). Multivariate analysis showed that internal fixation, fracture type (displacement), reduction quality (dissatisfaction), BMI (> 25), and ASA grade (III + IV) were independent risk factors affecting femoral head necrosis in patients with femoral neck fracture. 结果：随访1-15年，平均随访7.5年。250例患者中无骨折不愈合，40例（16%）发生股骨头坏死。手术后1-7年发生股骨头坏死，平均3.8年。单变量分析显示：骨折类型、复位质量、取出内固定、BMI、ASA分级等是股骨颈骨折后股骨头坏死的风险因素，有显著性差异（P<0.05）。多元分析显示：内固定、骨折类型（移位）、复位质量（不满意）、BMI（>25）、ASA分级（III+IV级）等是股骨颈骨折后股骨头坏死的风险因素。 Conclusion: A variety of high-risk factors for femoral head necrosis are present after surgery with hollow compression screws for femoral neck fracture in adults. Removal of internal fixation, type of fracture, quality of reduction, BMI, and ASA classification were the most important risk factors influencing the development of femoral head necrosis. During treatment, there should be some targeted measures to reduce the incidence of necrosis of the femoral head. 结论：成人股骨颈骨折后空心加压钉固定术后发生股骨头坏死的风险因素较多，其中取出内固定、骨折类型、复位质量、BMI、ASA分级等是引起股骨头坏死的主要危险因素，在治疗史，可采取针对性措施减少股骨头坏死发生。 图1. a 术前X线片；b 术后1年，X线片显示右股骨头坏死；c 术后2年随访 文献出处：Pei F, Zhao R, Li F, Chen X, Guo K, Zhu L. Osteonecrosis of femoral head in young patients with femoral neck fracture: a retrospective study of 250 patients followed for average of 7.5 years. J Orthop Surg Res. 2020 Jun 29;15(1):238. doi: 10.1186/s13018-020-01724-4. PMID: 32600432; PMCID: PMC7322831. |
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