股骨颈骨折空心钉固定术后股骨头坏死相关因素分析

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摘要目的探讨股骨颈骨折患者行空心钉固定术后发生股骨头坏死的相关因素。方法选取2014年4月至2016年2月行闭合复位经皮空心钉固定的108例股骨颈骨折患者进行回顾性研究，23例患者在术后随访期间出现股骨头坏死(阳性组)，85例未发生股骨头坏死(阴性组)，比较分析两组可能的相关因素。结果 21.30%的患者在随访中出现股骨头坏死。骨折Garden分型(P＝0.01)、体质指数(P＝0.02)以及术后股骨颈骨折端三维重建不同方向的移位是股骨头坏死发生的危险因素，而年龄、性别、术前是否牵引、等待手术时间、完全负重时间、内固定物是否取出在两组间比较差异无统计学意义(P＞0.05)。结论对于股骨颈骨折患者选择空心钉固定手术之前，应严格把握手术适应证，对于骨折移位明显、肥胖等出现股骨头坏死风险较高患者及时采用关节置换，术后适当减重以降低股骨头坏死发生。

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关键词 ：股骨颈骨折, 空心钉, 股骨头坏死, 身体质量指数

Abstract：ObjectiveTo investigate the related factors of avascular necrosis of femoral head after cannulated screw fixation in patients with femoral neck fracture.Methods A retrospective study of 108 patients diagnosed with femoral neck fracture by closed reduction and percutaneous cannulated screw fixation between April 2014and February 2016，23 patients had femoral head necrosis (positive group) and 85 had no femoral head necrosis (negative group) in postoperative follow-up，and analyzed the possible related factors of the two groups.Results 21.30% of patients suffered femoral head osteonecrosis during the follow-up.Farden type of fractype (P＝0.01)，Body mass Index (P＝0.02) and three-dimensional reconstruction of femoral neck fracture in different directions were the risk factors of osteonecrosis of femoral head，but age，sex，whether preoperative traction，time to wait for surgery，full weight-bearing time，whether the impants removed，there was no significant difference between two groups(P＞0.05).Conclusion For the patients with femoral neck fracture，we should strictly grasp the indications before the operation of cannulated screw fixation，and adopt hip replacement in time for the patients with high osteonecrosis risk such as sensible fracture displacement and obese，appropriate weight loss after surgery was necessary.

Key words： femoral neck fracture hollow nail femoral head necrosis body mass index

通讯作者: 赵文国

作者简介: 王瑞(1993－ )，男，研究生在读，华北理工大学附属医院骨外科，063000。

引用本文:

王瑞，薛栋，甘洪全，余向前，徐鹏，赵文国 *. 股骨颈骨折空心钉固定术后股骨头坏死相关因素分析[J]. 实用骨科杂志, 2018, 24(11): 982-986.
Wang Rui，Xue Dong，Gan HongQuan，et al. Related Factors Analysis of Femoral Head Osteonecrosis after Cannulated Screw Fixation in Femoral Neck Fracture. sygkzz, 2018, 24(11): 982-986.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2018/V24/I11/982

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