| 基于CT影像的中青年股骨颈骨折皮质碎片与股骨头缺血性坏死的相关研究 |
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投稿时间：2023-09-06
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| 作者 | Author | 单位 | Address | E-Mail |
| 陈芒芒 |
CHEN Mang-mang |
温州医科大学定理临床学院 温州市中心医院, 浙江 温州 325000 |
The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang, China |
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| 蔡晓盛 |
CAI Xiao-sheng |
温州医科大学定理临床学院 温州市中心医院, 浙江 温州 325000 |
The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang, China |
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| 吕杨训 |
LYU Yang-xun |
温州医科大学定理临床学院 温州市中心医院, 浙江 温州 325000 |
The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang, China |
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| 林胜磊 |
LIN Sheng-lei |
温州医科大学定理临床学院 温州市中心医院, 浙江 温州 325000 |
The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang, China |
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| 黄力鹏 |
HUANG Li-peng |
温州医科大学定理临床学院 温州市中心医院, 浙江 温州 325000 |
The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang, China |
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| 林洲 |
LIN Zhou |
温州医科大学定理临床学院 温州市中心医院, 浙江 温州 325000 |
The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang, China |
scarmonker@163.com |
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| 期刊信息：《中国骨伤》2024年，第37卷，第11期，第1096-1100页 |
| DOI：10.12200/j.issn.1003-0034.20230118 |
| 基金项目:温州市科技计划项目(编号:Y20210442) |
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中文摘要:
目的: 探讨基于CT影像的中青年股骨颈骨折内固定术后股骨颈皮质粉碎和外表面积对于缺血性坏死(avascular necrosis,AVN)的影响。
方法: 自2011年1月至2021年1月收集18~60岁的中青年股骨颈骨折采用3枚中空拉力螺钉倒三角固定病例218例,男104例,女114例;年龄19~60(48.22±10.58)岁。术前等待时间 ≤ 48 h为155例,术前等待时间为>48 h为63例;股骨颈皮质粉碎68例,其中皮质外表面积>25 mm2的32例。所有患者随访至少2年,分析比较患者年龄、性别、损伤侧别、身体质量指数、损伤机制、术前等待时间、手术时间、Garden分型、CT分析股骨颈皮质是否粉碎、大小、并发症情况与患者明确发生AVN的相关性,根据结果分为AVN组和非VAN组,单因素分析得到显著性差异的自变量,进一步行多元Logistic回归分析,确定AVN的独立危险因素。
结果: 通过单变量分析,AVN组和非AVN组在损伤机制(χ2=18.552,P=0.000),术前等待时间(χ2=2.065,P=0.033),Garden分型(χ2=12.598,P=0.006),皮质粉碎(χ2=16.357,P=0.000),皮质外表面积(χ2=23.371,P=0.000),差异均有统计学意义。多元Logistic回归表明:损伤机制高能量损伤[Exp(B)=3.487,95%CI(1.583,10.464),P=0.002],皮质粉碎[Exp(B)=2.494,95%CI(1.315,10.861),P=0.002];皮质外表面积>25 mm2[Exp(B)=22.161,95%CI(3.922,124.828),P=0.001]是股骨颈骨折内固定术后AVN的独立危险因素。
结论: 高能量损伤、股骨颈皮质粉碎和皮质外表面积>25 mm2是影响AVN的独立危险因素。股骨颈皮质碎片面积越大,合并上方股骨颈皮质碎片可能提示了一种更复杂更为严重的损伤。 |
| 【关键词】皮质粉碎 股骨颈骨折 缺血性坏死 |
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| Relationship between cortical fragments and avascular necrosis of femoral head in young adult femoral neck fractures based on CT imaging |
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ABSTRACT
Objective To explore the effect of femoral neck cortical fragments and surfacial area on avascular necrosis(AVN) after internal fixation of femoral neck fractures based on CT imaging in young adult.
Methods From January 2011 to January 2021,218 young and middle-aged patients with femoral neck fractures were reverse triangle fixed with three cannulated lag screws,including 104 males and 114 females;aged 19 to 60 years old with a mean of (48.22±10.58) years old. The preoperative waiting time ≤ 48 h was 155 cases,and the preoperative waiting time> 48 h was 63 cases; 68 cases were comminuted cortex of the femoral neck,32 of them with superficial area of the comminuted cortex>25 mm2. All patients were followed up for at least 2 years,the age,gender,injury side,body mass index,injury mechanism,preoperative waiting time,operation time,Garden classification,whether femoral neck cortex fracture and size by CT analysis and complications were analyzed the correlation to the definite occurrence of AVN. The AVN group and the non-AVN group were divided according to the final efficacy results.Univariate analysis yielded significant independent variables,Multiple Logistic regression analysis was further performed to identify the independent risk factors for AVN.
Results By univariate analysis,the AVN and non-AVN groups were significant in injury mechanism(χ2=18.552,P=0.000),preoperative waiting time(χ2=2.065,P=0.033),Garden classification (χ2=12.598,P=0.006),comminuted cortex (χ2=16.357,P=0.000),and the superficial area of the comminuted cortex(χ2=23.371,0.000,P=0.000). Multiple Logistic regression indicated injury mechanism high energy injury[Exp(B)=3.487,95%CI(1.583,10.464),P=0.002],comminuted cortex of the femoral neck[Exp(B)=2.494,95%CI(1.315,10.861),P=0.002];the superficial area of the comminuted cortex>25 mm2[Exp(B)=22.161,95%CI(3.922,1242.828),P=0.001] were independent risk factors for AVN after internal fixation of femoral neck fractures.
Conclusion High energy injury mechanism,with comminuted cortex of the femoral neck and the superficial area of the comminuted cortex> 25 mm2 were independent risk factors for AVN.The larger the superficial area of the cortex fragment may suggest more complicated injury mechanism and worse outcome. |
| KEY WORDS Communited Cortex Femoral neck fractures Avascular necrosis |
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| 中文格式: | 陈芒芒,蔡晓盛,吕杨训,林胜磊,黄力鹏,林洲.基于CT影像的中青年股骨颈骨折皮质碎片与股骨头缺血性坏死的相关研究[J].中国骨伤,2024,37(11):1096~1100 |
| 英文格式: | CHEN Mang-mang,CAI Xiao-sheng,LYU Yang-xun,LIN Sheng-lei,HUANG Li-peng,LIN Zhou.Relationship between cortical fragments and avascular necrosis of femoral head in young adult femoral neck fractures based on CT imaging[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(11):1096~1100 |
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