目的:分析患者,损伤模式,和治疗年轻患者股骨颈骨折(FNFs)与骨干骨折(assocFNFs)相关的FNFs,以改善临床结局。次要目标是将这种损伤模式与具有孤立FNFs(isolFNFs)的年轻患者的损伤模式进行比较。
方法:
方法:回顾性多中心队列系列。
方法:26个北美一级创伤中心。
■骨骼成熟患者,<50岁,用FNF手术固定治疗,有或没有相关的股骨干骨折。
■主要结果测量是治疗失败定义为不愈合,malunion,缺血性坏死,或随后的大翻修手术。还计算了这些治疗模式的赔率比。
结果:本研究中评估的80个组合FNFs和412个isolFNFs在患者方面是不同的,损伤模式,和治疗策略。具有assocFNFs的患者更年轻(33.3±8.6vs.37.5±8.7岁,P<0.001),平均体重指数[BMI]更大(29.7vs.26.6,P<0.001),更频繁地流离失所(95%与73%,P<0.001),“垂直取向”Pauwels3型,P<0.001(84%vs.43%)比isolFNFs,所有P值<0.001。AssocFNFs更常见于开放复位修复(74%vs.46%,P<0.001)和固定角度植入物(59%vs.39%)(P<0.001)。重要的是,与isolFNFs相比,assocFNFs的治疗失败较少(20%与49%,P<0.001),固定失败/骨不连和畸形愈合的发生率较低(分别为P<0.001和P=0.002)。治疗失败的几率[优势比(OR)=0.270,95%置信区间(CI),0.15-0.48,P<0.001],骨不连(OR=0.240,95%CI,0.10-0.57,P<0.001),和不愈合(OR=0.920,95%CI,0.01-0.68,P=0.002)也较低。在84.2%的assocFNFs减少和77.1%的isolFNFs中实现了优异或良好的减少(P=0.052)。用固定角度设备处理的AssocFNFs表现非常好,只有13.0%的治疗失败,而使用固定角度结构处理的isolFNFs为51.9%(P=<0.001),使用多个空心螺钉处理的assocFNFs为33.3%(P=0.034)。这项研究还确定了所谓的“架子”标志,在54%的assocFNFs和仅9%的isolFNFs中,颈部骨折的横向≥6-mm内侧-尾段(与垂直骨折线形成锐角)(P<0.001)。具有架子标志的AssocFNF在41例(12%)中只有5例失败。
结论:年轻患者的AssocFNFs具有不同的患者因素,损伤模式,和治疗,而不是isolFNF,尽管相关股骨干损伤需要混杂治疗,但预后相对较好。与用任何结构类型处理的isolFNF和用多个空心螺钉处理的assocFNF相比,用固定角度装置修复的assocFNF的治疗失败发生率较低。在超过一半的assocFNFs中发现放射学“架子标志”是积极的预后标志,并预测成功治疗的比率很高。
方法:治疗级别III。有关证据级别的完整描述,请参阅作者说明。
OBJECTIVE: To analyze patients, injury patterns, and treatment of femoral neck fractures (FNFs) in young patients with FNFs associated with shaft fractures (assocFNFs) to improve clinical outcomes. The secondary goal was to compare this injury pattern to that of young patients with isolated FNFs (isolFNFs).
METHODS: METHODS: Retrospective multicenter cohort series.
METHODS: Twenty-six North American level-1 trauma centers.
UNASSIGNED: Skeletally mature patients, <50 years old, treated with operative fixation of an FNF with or without an associated femoral shaft fracture.
UNASSIGNED: The main outcome measurement was treatment failure defined as nonunion, malunion, avascular necrosis, or subsequent major revision surgery. Odds ratios for these modes of treatment were also calculated.
RESULTS: Eighty assocFNFs and 412 isolFNFs evaluated in this study were different in terms of patients, injury patterns, and treatment strategy. Patients with assocFNFs were younger (33.3 ± 8.6 vs. 37.5 ± 8.7 years old, P < 0.001), greater in mean body mass index [BMI] (29.7 vs. 26.6, P < 0.001), and more frequently displaced (95% vs. 73%, P < 0.001), \"vertically oriented\" Pauwels type 3, P < 0.001 (84% vs. 43%) than for isolFNFs, with all P values < 0.001. AssocFNFs were more commonly repaired with an open reduction (74% vs. 46%, P < 0.001) and fixed-angle implants (59% vs. 39%) (P < 0.001). Importantly, treatment failures were less common for assocFNFs compared with isolFNFs (20% vs. 49%, P < 0.001) with lower rates of failed fixation/nonunion and malunion (P < 0.001 and P = 0.002, respectively). Odds of treatment failure [odds ratio (OR) = 0.270, 95% confidence interval (CI), 0.15-0.48, P < 0.001], nonunion (OR = 0.240, 95% CI, 0.10-0.57, P < 0.001), and malunion (OR = 0.920, 95% CI, 0.01-0.68, P = 0.002) were also lower for assocFNFs. Excellent or good reduction was achieved in 84.2% of assocFNFs reductions and 77.1% in isolFNFs (P = 0.052). AssocFNFs treated with fixed-angle devices performed very well, with only 13.0% failing treatment compared with 51.9% in isolFNFs treated with fixed-angle constructs (P = <0.001) and 33.3% in assocFNFs treated with multiple cannulated screws (P = 0.034). This study also identified the so-called \"shelf sign,\" a transverse ≥6-mm medial-caudal segment of the neck fracture (forming an acute angle with the vertical fracture line) in 54% of assocFNFs and only 9% of isolFNFs (P < 0.001). AssocFNFs with a shelf sign failed in only 5 of 41 (12%) cases.
CONCLUSIONS: AssocFNFs in young patients are characterized by different patient factors, injury patterns, and treatments, than for isolFNFs, and have a relatively better prognosis despite the need for confounding treatment for the associated femoral shaft injury. Treatment failures among assocFNFs repaired with a fixed-angle device occurred at a lower rate compared with isolFNFs treated with any construct type and assocFNFs treated with multiple cannulated screws. The radiographic \"shelf sign\" was found as a positive prognostic sign in more than half of assocFNFs and predicted a high rate of successful treatment.
METHODS: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.