股骨颈骨折内固定后发生股骨头缺血坏死的潜在多种危险因素剖析

Analysis of Multiple Potential Risk Factors for Avascular Necrosis of the Femoral Head after Internal Fixation of Femoral Neck Fractures

摘要: 目的：探究股骨颈骨折内固定术后发生股骨头缺血性坏死(Avascular Necrosis of the Femoral Head, ANFH)的危险因素，进一步分析挽救性全髋关节置换术(Total Hip Arthroplasty, THA)后的临床疗效。方法：回顾性分析2020年1月至2022年6月在我院因股骨颈骨折内固定术后发生ANFH行THA的79例患者的临床资料，另外，纳入同期206例为非缺血坏死组，通过单变量和多元Logistic回归分析确定并筛选出股骨颈骨折内固定后发生ANFH的独立危险因素。比较患者术前、术后1年、3年、5年髋关节Harris评分、髋部骨折功能恢复量表(Functional Recovery Scale, FRS)和疼痛视觉模拟量表(Visual Analogue Scale, VAS)，分析行THA后的中期临床疗效。结果：纳入多元Logistic回归分析筛选出的独立危险因素共3个指标，分别为：年龄(OR = 1.048, 95% CI: 1.025, 1.072, P < 0.001)、饮酒史(OR = 0.048, 95% CI: 0.268, 0.924, P = 0.027)和手术时间(OR = 0.972, 95% CI: 0.951, 0.993, P = 0.010)。THA治疗后1年、3年、5年髋关节Harris评分和FRS评分均明显高于治疗前(F = 412.827, F = 225.759, P < 0.001)，VAS评分明显低于治疗前(F = 128.783, P < 0.001)。结论：高龄、饮酒史、更长的手术时间被认为是股骨颈骨折内固定术后发生ANFH的独立预测因素，股骨颈骨折内固定失败后予以THA治疗后可改善患者的髋关节功能和生活质量。

Abstract: Objective: This paper aims to investigate the risk factors of Avascular Necrosis of the Femoral Head (ANFH) after internal fixation of femoral neck fracture, and further analyze the clinical efficacy of Total Hip Arthroplasty (THA). Method: The clinical data of 79 patients who underwent THA for ANFH after internal fixation of femoral neck fracture in our hospital from January 2020 to June 2022 were retrospectively analyzed. In addition, 206 patients were included in the non-ischemic necrosis group during the same period. The independent risk factors for ANFH after internal fixation of femoral neck fracture were identified and screened by univariate and multivariate Logistic regression analysis. Harris hip score, Functional Recovery Scale (FRS) and Visual Analogue Scale (VAS) were compared before, at 1, 3, and 5 years postoperatively. The mid-term clinical efficacy after THA was analyzed. Results: Three independent risk factors were screened out by multivariate Logistic regression analysis, including age (OR = 1.048, 95% CI: 1.025, 1.072, P < 0.001), drinking history (OR = 0.048, 95% CI: 0.268, 0.924, P = 0.027) and operation time (OR = 0.972, 95% CI: 0.951, 0.993, P = 0.010). Harris and FRS scores of hip joints at 1, 3 and 5 years after THA were significantly higher than those before THA (F = 412.827, F = 225.759, P < 0.001), and VAS scores were significantly lower than those before THA (F = 128.783, P < 0.001). Conclusions: Advanced age, drinking history, and longer operative time were considered to be independent predictors of ANFH after internal fixation of femoral neck fracture. THA treatment after failed internal fixation of femoral neck fracture could improve the hip function and quality of life of patients.