摘要
目的分析股骨颈骨折(femoral neck fracture,FNF)患者空心螺钉内固定(cannulated screw fixation,CSF)术后股骨头坏死的危险因素,并构建FNF患者CSF术后股骨头坏死的联合预测模型。方法回顾性分析2019年1月—2021年6月保定市第二中心医院骨科收治的205例接受CSF术治疗的FNF患者临床资料。其中男性86例,女性119例;年龄28~70岁,平均52.7岁;致伤原因:道路交通伤、高处坠落等高能量损伤103例,跌倒、碰撞等低能量损伤102例;Garden分型:Ⅰ型65例,Ⅱ型39例,Ⅲ型58例,Ⅳ型43例。根据CSF术后1年是否发生股骨头坏死分为股骨头坏死组52例和无股骨头坏死组153例。采用单因素和多因素Logistic回归分析FNF患者CSF术后股骨头坏死的危险因素,构建FNF患者CSF术后股骨头坏死的联合预测模型,采用受试者工作特征(receiver operating characteristic,ROC)曲线评价预测模型的效能。结果患者均随访1年,205例FNF患者共发生52例股骨头坏死,股骨头坏死发生率为25.37%(95%CI 23.98~26.76)。单因素分析显示,两组年龄、吸烟、糖尿病、高血压、Garden分型、骨折至手术时间、复位质量和术中出血量比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄≥60岁、吸烟、糖尿病、高血压、Garden分型Ⅲ~Ⅳ型、骨折至手术时间≥48h、复位质量不满意为FNF患者CSF术后股骨头坏死的危险因素(P<0.05)。联合预测模型及ROC分析显示:其对FNF患者CSF术后股骨头坏死有较高的评估效能,曲线下面积为0.855(95%CI 0.780~0.925)。结论FNF患者CSF术后股骨头坏死的危险因素包括年龄≥60岁、吸烟、糖尿病、高血压、Garden分型Ⅲ~Ⅳ型、骨折至手术时间≥48h、复位质量不满意,通过危险因素构建的联合预测模型预测患者CSF术后股骨头坏死的价值良好。
Objective To analyze the risk factors of femoral head necrosis after cannulated screw fixation(CSF)in patients with femoral neck fractures(FNFs),and to construct a combined prediction model for its incidence.Methods Clinical data of 205 FNF patients who were treated with CSF from Jan.2019 to Jun.2021 in our hospital were retrospectively analyzed.Among them,there were 86 males and 119 females aged 28-70 years,mean 52.7 years.High energy traumas like car accidents and falls from height occurred in 103 cases and low energy traumas like falls and collisions occurred in 102 cases.Garden classification showed 65 cases of type I,39 type II,58 type III and 43 type IV.According to whether femoral head necrosis occurred at 1 year after CSF,patients were divided into femoral head necrosis group with 52 cases and non-femoral head necrosis group with 153 cases.Univariate and multivariate logistic regression was used to analyze the risk factors for femoral head necrosis after CSF in FNF patients,and a combined prediction model was established.The receiver operating characteristic(ROC)curve was used to evaluate the efficacy of the prediction model.Results Patients were followed up for 1 year,when 52/205 FNF cases had femoral head necrosis,with the prevalence being 25.37%(95%CI 23.98-26.76).Univariate analysis revealed significant differences between two groups in terms of age,smoking history,diabetes,hypertension,Garden classification,time from fracture to operation,reduction quality and intraoperative blood loss(all P<0.05).Further multivariate logistic regression showed significant results regarding age≥60 years,smoking,diabetes,hypertension,GardenⅢ-Ⅳfractures,time from fracture to operation≥48 h and unsatisfactory reduction quality(all P<0.05).ROC curve analysis of the combined prediction model showed a high prediction value for the incidence of femoral head necrosis after CSF in FNF patients(AUC=0.855,95%CI 0.780-0.925).Conclusion For FNF patients,age≥60 years,smoking,diabetes,hypertension,GardenⅢ-Ⅳfractures,t
作者
郑美亮
李克鹏
帖小佳
薛宏伟
Zheng Meiliang;Li Kepeng;Tie Xiaojia;Xue Hongwei(Department of Orthopaedics,Baoding Second Central Hospital,Baoding,Hebei 072750,China)
出处
《创伤外科杂志》
2023年第5期354-360,共7页
Journal of Traumatic Surgery
基金
河北省医学科学研究课题计划(20201263)
河北省重点研发计划项目(21377762D)。
关键词
股骨颈骨折
空心螺钉
内固定
股骨头坏死
危险因素
Femoral neck fractures
Hollow screws
Internal fixation
Femoral head necrosis
Risk factors
