背景：股骨颈骨折内固定后发生股骨头坏死率较高，其危险因素一直没有明确的专家共识。目的：回顾性提出和分析60岁以下股骨颈骨折内固定后发生股骨头坏死的相关危险因素。方法：对199例60岁以下股骨颈骨折行闭合复位空心钉内固定的病例进行回顾性分析。对年龄，性别，体质量指数，Garden分型，骨折季节，骨折复位质量，内固定后完全负重下床时间7个因素进行统计分析，评估这些因素与股骨头坏死之间的关系。结果与结论：①199例股骨颈骨折患者内固定后股骨头坏死发生率13%；②体质量指数，Garden分型，骨折季节季节性变动及骨折复位质量与内固定后股骨头坏死密切相关。患者年龄、性别，内固定后负重时间与内固定后股骨头坏死无明显相关性；③Logistic 回归多因素分析，Garden 分型、骨折复位质量和骨折季节性变动(冬季 vs 夏季)对于股骨颈骨折后股骨头坏死的发展有明显影响；④结果提示，股骨颈骨折的Garden分型及骨折复位质量对股骨颈骨折术后愈合有很大的影响；冬季骨折可能是股骨颈骨折内固定后发生股骨头坏死的危险因素。%BACKGROUND:The incidence of femoral head necrosis after internalfixation in femoral neck fracture is at highlevel, but the risk factors are stil under discussion. OBJECTIVE:To retrospectively propose and analyze the relative risk factors of femoral head necrosis after internal fixationwithfemoral neck fracture in patients younger than60years old. METHODS:Data from199 patients with femoral neck fractures,younger than60years,undergoingclosed reduction and internal fixation were analyzed retrospectively.Seven factors including age, sex, body mass index, Garden classification, fracture seasons, reduction quality and weight-bearing time after internal fixation were statisticalyanalyzedto evaluate their correlation with femoral head necrosis. RESULTS AND CONCLUSION:The incidence of femoral head necrosis was 13.1%amongthe199 cases. Body mass index, Garden classification, fracture seasons, reduction quality were significantly associated with femoral head necrosis. The age, sex and weight-bearing time wereinsignificantly associated with femoral head necrosis. In multivariate logistic regression analysis, Garden classification, reduction quality and fracture seasons (winterversussummer) hadoverteffectson development of femoral head necrosis. These results suggest that Garden classification and reduction quality make an important effect on the healing of femoral neck fracture. In addition, fracture in winter may be the risk factor of the femoral head necrosis after internal fixation in femoral neck fracture.
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