庄至坤;许志庆;郭金花;龚志兵;吴昭克;

• 1:福建中医药大学附属泉州市正骨医院关节科

摘要(Abstract)：

[目的]探讨中青年股骨颈骨折闭合复位空心钉内固定术后股骨头坏死的相关因素及MRI的应用价值。[方法]回顾本科2012年1月～2017年1月闭合复位空心钉内固定术的208例中青年股骨颈骨折资料,比较MRI及X线片对术后股骨头坏死的检测结果,分析性别、年龄、Garden分型、是否急诊、骨折复位质量与术后是否发生股骨头坏死的相关性。[结果] 208例患者随访12～68个月,平均(28.12±9.04)个月,全部完成X线片随访检查,X线片检出43例(20.67%)坏死。其中158例完成规范的MRI,MRI检出102例(64.56%)坏死。208例患者中MRI和(或) X线片共检出110例(52.88%)。MRI的检出率高于X线片,差异具有统计学意义(P<0.05)。单因素比较显示坏死组与非坏死组在性别、是否急诊与术后股骨头坏死的差异无统计学意义(P>0.05),而在年龄、Garden分型、骨折复位质量的差异有统计学意义(P<0.05)。[结论]中青年股骨颈骨折空心钉内固定术后股骨头坏死是多因素影响的结果,其中年龄、Garden分型、骨折复位质量是相关危险因素,而性别、是否急诊关系不密切。

关键词(KeyWords)： 股骨颈骨折;中青年;空心钉;股骨头坏死;相关因素

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 庄至坤;许志庆;郭金花;龚志兵;吴昭克;

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参考文献(References)：

• [1] KaPlan T, Akesen B, Demirag B, et al. Comparative results of percutaneous cannulated screws, dynamic compression type Plate and screw for the treatment of femoral neck fractures[J]. Ulus Travma Acil Cerrahi Derg, 2012, 18(1):65-70.
• [2] Enocson A, LaPidus LJ. The vertical hip fracture-a treatment challenge. A cohort study with an up to 9 year follow-up of 137 consecutive hips treated with sliding hip screw and antirotation screw[J].BMC Musculoskel Disord, 2012, 13(1):171.
• [3]谢康,高维陆,常俊,等.股骨颈骨折修复后股骨头坏死7个相关因素:199例回顾分析[J].中国组织工程研究, 2016, 24(20):3529-3533.
• [4] 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):1117-1123.
• [5] Embden D, Roukema GR, Rhemrev SJ, et al. The pauwels classification for intracapsular hip fractures:Is it reliable[J]. Injury,2011, 42(11):1238-1240.
• [6]张德濒,易雪冰,钟鉴.不同病因致股骨头缺血性坏死的影像对比[J].中国组织工程研究, 2013, 48(17):8455-8460.
• [7] Amit Aggarwal, Mahi PalSingh, Aditya N Aggarwal, et al. Assessment of interobserver variation in Garden classification and management of fresh intracapsular femoral neck fracture in adults[J].Chin J Traumatol, 2014, 17(2):99-102.
• [8]孙民海,张胜强.不同时间段空心加压螺钉内固定治疗老年移位型股骨颈骨折疗效分析[J].中国骨质疏松杂志, 2013, 2(19):161-163.
• [9] Sen RK, TriPathy SK, Goyal T, et al. Osteosynthesis of femoralneck nonunion with angle blade plate and autogenous fibular graft[J]. Int Orthop, 2012, 36(4):827-832.
• [10]孙友强,陈雷雷,刘予豪,等.股骨颈骨折内固定后股骨头坏死发生研究现状[J].中国组织工程研究, 2017, 19(21):3096–3100.
• [11]高悠水,陈松,周祖彬,等. Pauwels 3型股骨颈骨折的手术治疗46例分析[J].中国骨与关节杂志, 2015, 4(2):96-100.
• [12]张浩,史雪峰,杨春宝,等.三枚与四枚螺钉置入治疗Pauwels III型股骨颈骨折的有限元分析[J].中国组织工程研究, 2016,20(26):3897-3901.
• [13] Zhang Y, Tian L, Yan Y, et al. Biomechanical evaluation of the expansive cannulated screw for fixation of femoral neck fractures[J].Injury, 2011, 42(11):1372-1376.
• [14] Zdero R, Keast-Butler O, Schemitsch EH. A biomechanical comparison of two triple-screw methods for femoral neck fracture fixation in a synthetic bone model[J]. Trauma, 2010, 69(6):1537-1544.
• [15] Saglam N, Kucukdurmaz F, Kivilcim H, et al. Biomechanical comparison of antirotator compression hip screw and cannulated screw fixations in the femoral neck fractures[J]. Acta Orthop Traumatol Turc, 2014, 48(2):196-201.
• [16] Duckworth AD, Bennet SJ, Derinto JA, et al. Fixation of intracapsular fractures of the femoral neck in young patients[J]. J Bone Joint Surg Am, 2011.93(6):811-816.
• [17] Sathiyakumar V, Greenberg SE, Molina CS, et al. Hip fractures are risky business:an analysis of the NSQIP data[J]. Injury, 2015, 46(4):703-708.
• [18] Spence D, Dimauro JP, Miller PE, et al. Osteonecrosis after femoral neck fractures in children and adolescents:analysis of risk factors[J]. J Pediatr Orthop, 2016, 36(2):111-116.
• [19]赵红星,黄媛霞,梁秋冬,等.股骨颈骨折内固定术后股骨头坏死的相关危险因素分析[J].西安交通大学学报(医学版),2016, 6(37):906-909.
• [20]黄文良,邓江,莫刚,等.老年股骨颈骨折内固定术后患者股骨头缺血性坏死的相关因素[J].中国老年学杂志, 2013, 33(17):4268-4270.
• [21] Basso T, Klaksvik J, Syversen U, et al. Biomechanical femoral neck fracture experiments-a narrative review[J]. Injury, 2012, 43(10):1633-1639.
• [22] Sugamoto K, Ochi T, Takahashi Y, et al. Hemodynamic measurement in the femoral head using laser DoPPler[J]. Clin Orthop,1998, 353:138-147.
• [23] Min BW, Kim SJ. Avascular necrosis of the femoral head after osteosynthesis of femoral neck fracture[J]. Orthopedics, 2011, 34(5):349.
• [24] Yeranosian M, Horneff JG, Baldwin K, et al. Factors affecting the outcome of fractures of the femoral neck in children and adolescents:a systematic review[J]. Bone Joint J, 2013, 95(1):135-142.
• [25] Slobogean GP, Sprague SA, Scott T, et al. Complications following young femoral neck fractures[J]. Injury,2015, 46(3):484-491.
• [26] Kawasaki M, Hasegawa Y, Sakano S, et al. Prediction of osteonecrosis by magnetic resonance imaging after femoral neck fractures[J]. Clin Orthop, 2001, 385(385):157-164.
• [27] Yuan HF, Shen F, Zhang J, et al. Predictive value of single photon emission computerized tomography and computerized tomography in osteonecrosis after femora neck fracture:a prospective study[J].Int Orthop, 2015, 39(7):1417-1422.