Abstract:Objective To explore factors related to occurrence of osteonecrosis of femur head after femur neck fracture with the treatment of hollow screws and sartorius iliac flap transplant.Methods A total of 113 patients of femur neck fractures treated by hollow screws and sartorius iliac flap transplant between February 2005 and January 2015 were analyzed in our hospital.Patients were divided into non-osteonecrosis of femur head group and osteonecrosis of femur head group according to the occurrence of osteonecrosis of femur head at last follow-up.According to clinical information and imaging data,we selected some factors such as gender,age,time from injury to operation,Garden type of fracture,operation time,quality of reduction,weight bearing time and removal of screws,which may affect the occurrence of osteonecrosis of femur head after operation.The selected factors were grouped and assigned.After excluding unrelated factorsby one-way chi-square test analysis,multivariable Logistic regression ereused to analyze the data.Results 113 patients were followed up for 23~105 months.A total of 23 patients had osteonecrosis of femur head occurred at last follow-up.After one-way chi-square test analysis to the above 8 factors,there was statistic significance between groups about Garden type of fracture,operation time and quality of reduction(P<0.05),and there was no statistic significance about other factors(P>0.05).Multiariable Logistic regression analysis showed,Garden type of fracture was the independent influencing factor for occurrence of osteonecrosis of femur head after femur neck fracture with the treatment of hollow screws and sartorius iliac flap transplant.Conclusion Type of fracture after injury initially affectsoccurrence of osteonecrosis of femur head after femur neck fracture with the treatment of hollow screws and sartorius iliac flap transplant.Reduction at the first time and reduced operation timecanimproving quality of reduction and reduce the rate of occurrence of osteonecrosis of femur head.
程根熙. 缝匠肌骨瓣加内固定治疗青壮年股骨颈骨折后股骨头坏死分析[J]. 实用骨科杂志, 2017, 23(7): 604-608.
Cheng Genxi. Osteonecrosis of Femur Head after Femur Neck Fracture with the Treatment of Internal Fixation and Sartorius Iliac Flap Transplant. sygkzz, 2017, 23(7): 604-608.
[1]Min BW,Kim SJ.Avascular necrosis of the femoral head after osteosynthesis of femoral neck fracture[J].Orthopedics,2011,34(5):349.
[2]杨火发,郭应林,聂文波.缝匠肌骨瓣移植术与加压螺纹钉联合治疗中青年股骨颈骨折[J].中国修复重建外科杂志,2006,20(11):1073-1075.
[3]万里,祝雁冰,关中伟,等.空心钉内固定加缝匠肌髂骨瓣移植治疗青壮年股骨颈骨折[J].创伤外科杂志,2010,12(5):405-407.
[4]Zhang C,Zeng B,Xu Z,et al.Treatment of femoral head necrosis with free vascularized fibula grafting:a preliminary report[J].Microsurgery,2005,25(4):305-309.
[5]张长青,王坤正,曾炳芳,等.应用吻合血管的游离腓骨移植治疗陈旧性股骨颈骨折[J].中华创伤骨科杂志,2004,6(8):858-860;870.
[6]尚宏喜,刘安庆,肖德明.腓骨带血管移植联合加压螺纹钉固定治疗高危型青壮年股骨颈骨折16例[J].实用医学杂志,2008,24(8):1364-1366.
[7]康龙.缝匠肌骨瓣血供特点及临床应用[J].解剖与临床,2003,8(4):203-204.
[8]吴剑,张柘,秦星星,等.缝匠肌骨瓣转移在青壮年陈旧性股骨颈骨折中的应用[J].实用骨科杂志,2017,23(5):400-403.
[9]Beris AE,Payatakes AH,Kostopoulos VK,et al.Nonunion of femoral neck fractures with osteonecrosis of the femoral head:treatment with combined free vascularized fibular graftingand subtrochanteric valgus osteotomy[J].Orthop Clin North Am,2004,35(3):335-343.
[10]Wang T,Sun JY,Zha GC,et al.Analysis of risk factors for femoral head necrosis after internal fixation in femoral neck fractures[J].Orthopedics,2014,37(12):e1117-1123.
[11]顾小明,黄立新.股骨颈骨折空心加压螺钉内固定后股骨头坏死分析[J].实用骨科杂志,2014,20(10):900-905.
[12]Song HK,Choi HJ,Yang KH.Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years[J].Injury,2016,47(12):2743-2748.
[13]孙欣,曾荣,胡资兵,等.空心螺钉内固定治疗股骨颈骨折术后股骨头坏死的影响因素分析[J].中华创伤骨科杂志,2012,14(6):477-479.
[14]陈广辉,王洪伟,吴琼,等.儿童股骨颈骨折疗效及股骨头坏死相关因素分析[J].实用骨科杂志,2017,23(5):404-408.