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| 顺行髓内钉治疗股骨干骨折后发生股骨头坏死的原因分析 |
| Causes analysis of Osteonecrosis of the Femoral Head(ONFH) after intramedullary nailing of femoral shaft fractures |
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| DOI：10.3969/j.issn.1006-7108.2019.02.006 |
| 中文关键词: 股骨干骨折 股骨头坏死 髓内钉 并发症 骨质疏松症 |
| 英文关键词:Femoral shaft fracture Osteonecrosis of the femoral head Intramedullary Nailing Complications osteoporosis |
| 基金项目:国家自然科学基金面上项目（81672236，81372013）；北京市自然科学基金面上项目（7182146） |
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| 中文摘要: |
| 目的 探讨股骨干骨折经顺行髓内钉治疗后与股骨头坏死发生的关系。方法 对我院诊治的47例采用顺行髓内钉治疗的股骨干骨折患者进行回顾性研究；平均年龄55.3岁（18～95岁）；男31例，女16例。骨折的AO分型：A型14例，B型27例，C型6例。车祸所致者14例，高处坠落者11例，摔倒者22例。大转子顶点进钉38例，梨状窝进钉9 例。采用卡方检验探索骨折分型、年龄、是否合并骨质疏松、进钉点位置与股骨头坏死的关系。当期望计数小于5时，采用Fisher精确检验结果。结果 股骨头坏死发生与年龄、AO分型、骨质疏松无明显相关性，进钉点位置的选取对发生股骨头坏死有显著性影响（P＜0.05）。3例股骨头坏死患者均采用了梨状窝进钉点。结论 进钉点选择不当可能造成股骨头血供受损，针对髓内钉治疗股骨干骨折推荐采用大转子顶点作为进钉点。 |
| 英文摘要: |
| Objective To analyze the incidence of Osteonecrosis of the Femoral Head(ONFH) after intramedullary nailing of femoral shaft fractures.Methods A retrospective study was conducted within 47 patients (average age 55.3 years,range 18-95 years) who underwent clinic treatments in our hospital,including 31 males and 16 females.The AO classification were divided into three types A, B and C. 14 cases were type A, 27 cases were type B and 6 cases were type C.The mechanism of injury included three types. 14 patients were caused by car accident, 11cases were falling accidents. 22 patients tumbled. The number of cases with the entry point at the tip of the greater trochanter or piriformis fossa was 38 and 9. The incidence of ONFH was examined using the chi-square test or Fisher’s exact test when 1 or more cell of the cells has an expected frequency of 5 or less. ResultsThere was no significant correlation between ONFH and age, AO classification , osteoporosis. The entry point has significant effect on ONFH (p=0.033<0.05). The entry point of the three ONFH cases were both at piriformis fossa. ConclusionOur findings suggest that inappropriate entry point may cause damage to the blood supply of the femoral head.The entry point at the tip of the greater trochanter should be recommended for the treatment of femoral shaft fractures with intramedullary nail. |
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