股骨颈骨折内固定术后股骨头坏死的因素

Factors related to femoral head necrosis after internal fixation of femoral neck fracture

摘要:

[目的] 探讨股骨颈骨折 （femoral neck fracture, FNF） 内固定术后股骨头坏死 （femoral head necrosis, FHN） 的因素。 [方法] 2021 年 1 月—2023 年 1 月 100 例 FNF 患者在全麻下接受骨折复位内固定治疗，术后平均随访 （2.1±0.4） 年，观察 FHN 发生情况。比较并分析 FHN 组与非 FHN 组一般资料，以及血清内皮素-1 （Endothelin-1, ET-1） 和基质金属蛋白酶-13 （matrix metalloproteinase, MMP-13）。[结果] 100 例患者中 21 例发生 FHN。单项因素比较表明，FHN 组 Garden 分型严重程度比率 [例, I~II/III~IV, (8/13) vs (58/21), P=0.002]、合并糖尿病比率 [例, 是/否, (7/14) vs (10/69), P=0.025]、合并高血压 [例, 是/否, (8/ 13) vs (13/66), P=0.030]、血清 ET-1 水平 [(7.8±1.8) μg/L vs (6.4±1.5) μg/L, P＜0.001]、MMP-13 水平 [(42.1±4.3) μg/L vs (36.4±4.0) μg/L, P＜0.001] 均显著高于非 FHN 组，尽管两组在年龄、性别、体质指数、骨折侧别、骨折原因的差异均无统计学意义 （P＞ 0.05）。二元多因素逻辑回归表明，Garden 分型重 （OR=3.056, 95%CI: 1.597~11.686）、合并糖尿病 （OR=2.430, 95%CI: 1.640~ 8.790）、血清 ET-1 水平高 （OR=2.694, 95%CI: 1.537~9.570）、MMP-13 水平高 （OR=2.745, 95%CI: 1.455~10.708） 是 FNF 患者内固定术后 FHN 的危险因素。[结论]血清 ET-1、MMP-13 与 FNF 患者术后 FHN 关系密切。

Abstract:

[Objective] To explore the factors related to femoral head necrosis (FHN) after internal fixation of femoral neck fracture (FNF). [Methods] From January 2021 to January 2023, 100 patients received reduction and internal fixation under general anesthesia for FNF, and followed up for a mean of (2.1±0.4) years to observe whether FHN happened. The general data and serum levels of endothelin-1 (ET-1) and matrix metalloproteinase (MMP-13) were compared and analyzed between the FHN group and non-FHN group. [Results] FHN occurred in 21 of the 100 patients. In term of univariate comparison, the FHN group proved significantly greater than the non-FHN group regarding to ratio of severe Garden classification [I~II/III~IV, (8/13) vs (58/21), P=0.002], the ratio of combined diabetes [yes/no, (7/14) vs (10/69), P=0.025], combined hypertension [yes/no, (8/13) vs (13/66), P=0.030], serum levels of ET-1 [(7.8±1.8) μg/L vs (6.4±1.5) μg/L, P＜ 0.001] and MMP-13 [(42.1±4.3) μg/L vs (36.4±4.0) μg/L, P＜0.001], despite of the fact that there were no statistically significant differences in age, sex, body mass index, fracture side and fracture cause between the two groups (P＞0.05). As results of binary multi-factor logistic regression , the severe Garden grade (OR=3.056, 95%CI: 1.597~11.686), diabetes mellitus (OR=2.430, 95%CI: 1.640~8.790), high serum ET-1 level (OR=2.694, 95%CI: 1.537~9.570) and high level of MMP-13 (OR=2.745, 95%CI: 1.455~10.708) were risk factors for FHN after internal fixation of FNF. [Conclusion] Serum ET-1 and MMP-13 are closely related to postoperative FHN in patients who had FNF fixed.