摘要
目的探讨股骨颈骨折内固定术后骨折不愈合或畸形愈合的危险因素。方法回顾性分析潍坊市人民医院创伤骨科2013年1月至2019年6月期间收治的140例股骨颈骨折患者资料。男61例,女79例;年龄为18~65岁,平均51.3岁;所有患者均复位后行3枚空心螺钉"倒三角"形固定。对其年龄、性别、损伤侧别、骨折Garden分型、受伤至手术时间、骨折复位质量、术后下地扶拐不负重活动时间、术前骨密度、术前25羟维生素D3浓度9个因素进行单因素分析,再将P<0.05的因素进行多因素logistic回归分析,以确定股骨颈骨折内固定术后骨折不愈合或畸形愈合的危险因素。P<0.05认为差异有统计学意义。结果140例患者术后获6~12个月(平均10.8个月)随访。共有25例(17.86%)患者发生骨折不愈合或畸形愈合。多因素logistic回归分析结果显示:骨折GardenⅢ、Ⅳ型(OR=2.873,95%CI:1.027~8.039,P=0.044)、非解剖复位(OR=4.678,95%CI:1.133~19.310,P=0.033)、术后<3个月下地扶拐不负重活动(OR=0.230,95%CI:0.072~0.737,P=0.013)、术前25羟维生素D3浓度<30 ng/mL(OR=3.718,95%CI:1.337~10.341,P=0.012)是股骨颈骨折患者内固定术后骨折不愈合或畸形愈合的危险因素。结论骨折GardenⅢ、Ⅳ型、非解剖复位、术后<3个月下地扶拐不负重活动、术前25羟维生素D3浓度<30 ng/mL是股骨颈骨折内固定术后骨折不愈合或畸形愈合的危险因素。
Objective To explore the risk factors for nonunion or malunion after internal fixation of femoral neck fracture.Methods A retrospective analysis was done of the 140 patients with femoral neck fracture who had been admitted to Department of Traumatology and Orthopedics,Weifang People's Hospital from January 2013 through June 2019.They were 61 males and 79 females,aged from 18 to 65 years(average,51.3 years).All patients received"inverted triangle"internal fixation with 3 hollow nails after reduction.The univariate analysis was conducted of the 9 factors:age,gender,fracture side,Garden classification,injury-to-operation time,reduction quality,postoperative ambulation with crutches but no weight-bearing,preoperative bone density,and preoperative 25-hydroxyvitamin D3 concentration.Multivariate logistic regression analysis was used for the factors with P<0.05 to identify risk factors.P<0.05 was considered statistically significant.Results This cohort of 140 patients obtained follow-up for 6 to 12 months(average,10.8 months).Nonunion or malunion occurred in 25 cases of them(17.86%).The multivariate logistic regression analysis showed that Garden typesⅢ&Ⅳ(OR=2.873,95%CI:1.027~8.039,P=0.044),non-anatomic reduction(OR=4.678,95%CI:1.133~19.310,P=0.033),postoperative ambulation time with crutches but no weight-bearing<3 months(OR=0.230,95%CI:0.072~0.737,P=0.013),and preoperative 25-hydroxyvitamin D3 concentration<30 ng/mL(OR=3.718,95%CI:1.337~10.341,P=0.012)were the risk factors for nonunion or malunion after internal fixation of femoral neck fracture.Conclusion The risk factors for nonunion or malunion after internal fixation of femoral neck fracture may be the Garden typesⅢ&Ⅳ,non-anatomic reduction,postoperative ambulation time with crutches but no weight-bearing<3 months,and preoperative 25-hydroxyvitamin D3 concentration<30 ng/mL.
作者
滕延斌
李亭亭
王磊
罗文明
Teng Yanbin;Li Tingting;Wang Lei;Luo Wenming(Department of Traumatology and Orthopedics,Weifang People's Hospital,Weifang 261041,China;Department of Ultrasound,Weifang Maternal and Child Health Hospital,Weifang 261041,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2020年第9期799-803,共5页
Chinese Journal of Orthopaedic Trauma
关键词
股骨颈骨折
骨折固定术
内
骨折
不愈合
危险因素
回归分析
Femoral neck fractures
Fracture fixation,internal
Fractures,nonunion
Risk factors
Regression analysis
作者简介
通信作者:王磊,Email:1771461075@qq.com。
