内固定术后股骨颈短缩的多因素分析及其对骨折的影响

目的:分析股骨颈短缩的发生率、对骨折愈合造成的影响以及造成颈短缩的影响因素。方法:选择在我院行闭合复位空心钉内固定术治疗并成功获得随访信息的老年股骨颈骨折患者106例作为研究对象。于术后1、3、6、12个月对患者进行门诊随访,记录患者的髋关节Harris评分、骨折愈合情况以及颈短缩的发生率,并将患者分为短缩组和无短缩组,对两组患者的骨折愈合率与髋关节Harris评分进行对比,并分析空心钉内固定术后颈短缩发生的危险因素。结果:短缩组43例,未短缩组63例。短缩组中骨折愈合率93.02%;未短缩组中骨折愈合率93.65%,两组骨折愈合率的差异无统计学意义(P>0.05)。短缩组中术后髋关节Harris评分为(74.58±7.85)分;未短缩组中术后髋关节Harris评分为(85.69±11.34)分,短缩组Harris评分低于未短缩组,差异有统计学意义(P<0.05)。颈短缩的发生与年龄、性别、骨折类型、骨密度值及骨折复位质量密切相关(P<0.05),与受伤至手术时间、置入方式、负重时间、住院时间无明显的相关性(P>0.05)。颈短缩的发生与骨密度值和骨折复位质量相关性最大,骨折类型与年龄次之,性别的相关性相对较小。结论:空心钉内固定治疗股骨颈骨折并发颈短缩的发生率较高,颈短缩会影响髋关节的功能,但不影响骨折的愈合。骨密度、骨折复位质量、骨折类型、年龄以及性别是颈短缩的独立影响因素。

Multivariate Analysis of Femoral Neck Shortening after Internal Fixation and its Influence to Fracture

Objective: To analyze the incidence of femoral neck shortening,the impact on fracture healing and the influencing factors of neck shortening.Methods: 106 old patients with femoral neck fractures and complete follow-up information who were treated by closed reset cannulated screw fixation in our hospital were selected as subjects.Patients were followed up through outpatient after 1,3,6,12 months of the surgery.The Harris hip score,fracture healing process and the incidence of neck shortening were recorded.Patients were divided into the shortening group and the non-shortening group.The healing rate and the Harris hip score of the two groups were compared and the risk factors of neck shortening after cannulated screw fixation were analyzed.Results: There were 43 cases in the shortening group and 63 cases in the non-shortening group.The healing rate in the shortening group was 93.02% while that was 93.65% in the non-shortening group.The differences between the two groups were not statistically significant(P> 0.05).The postoperative Harris hip score in the shortening group was(74.58 ±7.85) points while it was(85.69±11.34) points in the non-shortening group.The Harris hip score was lower than that in the non-shortening group.The difference was statistically significant(P<0.05).Neck shortening was closely related with age,gender,fracture type,Bone mineral density value,and fractures reduction quality(P<0.05) while it didn’t show a significant correlation between the time from injury to surgery,placement types,weight time and length of stay(P>0.05).The correlation between bone mineral density values and fracture reduction quality and the occurrence of neck shortening was the most,fracture type and age was next,and gender was the least.Conclusions: The incidence of femoral neck shortening after cannulated screw fixation might be rather high.The shortening might have a negative impact on hip functioning but not on fracture healing.Bone density,fractures reduct-ion quality,fracture type,age and gender were the independent factors of neck shortening.