■本研究的目的是调查老年股骨粗隆间骨折患者头端髓内钉术后股骨头坏死(ONFH)的发生率,并分析其相关危险因素。
■我们共招募了689名连续的头端髓内钉治疗股骨粗隆间骨折的患者。其中,最终纳入符合纳入标准的368例患者。通过查看患者的电子图表和系列X光片,确定了头髓钉固定后的ONFH。然后将ONFH组与非ONFH组进行比较。
■在368例患者中有9例(2.4%)发现了ONFH。ONFH的诊断时间平均为23.8个月(范围,5-54个月)索引手术后。平均年龄,身体质量指数,骨密度(股骨颈T评分)为84.1±7.1岁,分别为23.7±3.6kg/m2和-3.1±0.7kg/m2。从受伤到手术,从入院到手术,手术时间平均为4.2±2.7天,3.6±2.6天,87.2±30.0分钟,分别。在9名患者中,3例进行了转换关节成形术。ONFH组高龄(p=0.029),更多的股骨颈骨折成分(p=0.002),与非ONFH组相比,减少不足(p=0.045)。在多变量分析中,高龄(赔率比[OR],1.61;,p=0.022),股底骨折成分(OR,24.58;p=0.001),和不足的减少(或,4.11;p=0.039)被确定为ONFH的危险因素。
■虽然ONFH在老年患者股骨粗隆间骨折的头端髓内钉固定后比较少见,它的风险可能随着年龄的增长而增加,股颈骨折的组成部分,和不足的减少。因此,在有这些危险因素的患者中,即使在骨愈合后,也需要细致和更长时间的随访。
UNASSIGNED: The objective of this
study was to investigate the incidence of osteonecrosis of the femoral head (ONFH) after cephalomedullary nailing in elderly patients with pertrochanteric fractures and to analyze the risk factors related to ONFH.
UNASSIGNED: A total of 689 consecutive patients with cephalomedullary nailing for pertrochanteric fractures at our hospital were recruited. Of these, 368 patients who met the inclusion criteria were finally enrolled. ONFH after cephalomedullary nailing was identified by reviewing patients\' electronic charts and serial radiographs. The ONFH group was then compared with the non-ONFH group.
UNASSIGNED: ONFH was identified in 9 of 368 patients (2.4%). The time to diagnosis of ONFH averaged 23.8 months (range, 5-54 months) after index surgery. The mean age, body mass index, and bone mineral density (T-score in femur neck) were 84.1 ± 7.1 years, 23.7 ± 3.6 kg/m2, and -3.1 ± 0.7 kg/m2, respectively. The times from injury to surgery, from admission to surgery, and operation time averaged 4.2 ± 2.7 days, 3.6 ± 2.6 days, and 87.2 ± 30.0 minutes, respectively. Among 9 patients, 3 underwent conversion arthroplasty. The ONFH group had advanced age (p = 0.029), more basicervical fracture components (p = 0.002), and inadequate reduction (p = 0.045) compared to the non-ONFH group. On multivariate analysis, advanced age (odds ratio [OR], 1.61;, p = 0.022), basicervical fracture components (OR, 24.58; p = 0.001), and inadequate reduction (OR, 4.11; p = 0.039) were identified as risk factors of ONFH.
UNASSIGNED: Although ONFH is relatively rare after cephalomedullary nailing for pertrochanteric fractures in elderly patients, its risk may increase with advanced age, basicervical fracture components, and inadequate reduction. Therefore, in patients with these risk factors, meticulous and longer follow-up is needed even after bone union.