中青年股骨颈骨折空心钉内固定术后并发股骨头坏死的临床研究
发布时间：2018-09-18 07:19
【摘要】：目的:探讨磁共振成像(magnetic resonance imaging,MRI)应用于股骨颈骨折空心钉内固定术后并发股骨头坏死早期诊断的时机及相关中医症候以及坏死分期,可为今后中青年股骨颈骨折后股骨头坏死(osteonecr osis of the femoral head,ONFH)的早期治疗提供明确适应症和保髋方案。方法:研究对广西中医药大学第一附属医院、瑞康医院骨科于2011年1月1日至2016年10月30日期间住院病人股骨颈骨折空心钉内固定术术后患者,选出符合纳入标准81例共81髋的病例进行回顾性研究。对中青年股骨颈骨折进行空心钉内固定手术后的患者回顾性分析观察M RI及X线片在骨折术后3~6月51例患者、7~12月16例患者、13~20月9例患者、≥21月5例患者的不同时期的临床资料进行评估,中医症候分型分为:筋脉瘀滞型和肝肾亏虚型。骨折分型参照Garden分型、坏死分期参照ARCO分期进行分型,计数资料的对照采用χ2检验,等级资料采用秩和检验,计量资料用均数加减标准差(sx?)表示,组间比较采用单因素方差分析,P0.05表示差异有统计学意义,以影像学上出现ON FH为观察终点,进行Kaplan-Meier生存曲线分析。结果:(1)MRI和X线以发生ONFH为观察节点生存曲线在3月~6月、7月~12月存在差异。本组病例在术后各时期首诊及复诊的MRI诊断并发ONFH结果均为一致。术后不同时期,MRI检查较X线片检查发现股骨颈骨折术后并发股骨头坏死的敏感度不同。其中,3~6月和7~12月,MRI和X线片提示股骨颈骨折术后并发ONFH征象的精确度和敏感度有显著差异(P0.05);13~20月及≥21个月,MRI和X线片提示股骨颈骨折术后并发股骨头坏死征象的精确度和敏感度差异均无统计学意义(P0.05)。(2)随时间变化,股骨颈骨折后并发股骨头坏死的ARCO分期发生进展。其中发现(ARCOI期)时间段为3~18月,平均(7.992士5.05)月;发现(ARCOII期)时间段为4~28月,平均(15.189士5.987月;发现(AR COIII、IV期)时间段为10~36月,平均(19.65士7.398)月。(3)股骨颈骨折术后Harris评分高低对股骨头坏发生率存在相关性。(4)Garden分型对股骨颈骨折术后对并发股骨头坏死存在相关性。(5)外伤性股骨头坏死在不同时间段中医症侯具有差异。结论:股骨颈骨折患者术后3个月行常规MRI检查即极大可能可以排除并发股骨头坏死,并且可以准确诊断已并发股骨头坏死。在股骨颈骨折后1年内,MRI诊断并发股骨头坏死的价值远高于X线片,MRI和X线片在生存曲线上1年内生存率存在差异。股骨颈骨折术后髋关节Ha rris评分越高,股骨头坏死率越低。Garden分型对股骨颈骨折术后并发股骨头坏死具有相关性。骨折后根据不同时间段进行中医辨证分型有助于早期诊断并发的骨蚀分型指导其辩证治疗。
[Abstract]:Objective: to investigate the time of early diagnosis of femoral head necrosis after hollow nail fixation with magnetic resonance imaging (magnetic resonance imaging,MRI) and the related TCM symptoms and stages of necrosis. It can provide definite indication and hip preservation scheme for the early treatment of femoral head necrosis (osteonecr osis of the femoral head,ONFH) after femoral neck fracture in young and middle-aged people. Methods: from January 1, 2011 to October 30, 2016, the orthopaedic department of Ruikang Hospital, the first affiliated Hospital of Guangxi University of traditional Chinese Medicine, studied the postoperative patients with femoral neck fracture treated by hollow nail fixation. A retrospective study was conducted in 81 cases (81 hips) according to the inclusion criteria. A retrospective study of 51 patients with M RI and X ray radiographs after internal fixation of femoral neck fractures in young and middle-aged patients was conducted from 3 to 6 months after operation. There were 16 patients with femoral neck fractures from 7 months to 12 months and 9 patients from 13 to 20 months after operation. The clinical data of 5 patients with 鈮，
本文编号：2247190
[Abstract]:Objective: to investigate the time of early diagnosis of femoral head necrosis after hollow nail fixation with magnetic resonance imaging (magnetic resonance imaging,MRI) and the related TCM symptoms and stages of necrosis. It can provide definite indication and hip preservation scheme for the early treatment of femoral head necrosis (osteonecr osis of the femoral head,ONFH) after femoral neck fracture in young and middle-aged people. Methods: from January 1, 2011 to October 30, 2016, the orthopaedic department of Ruikang Hospital, the first affiliated Hospital of Guangxi University of traditional Chinese Medicine, studied the postoperative patients with femoral neck fracture treated by hollow nail fixation. A retrospective study was conducted in 81 cases (81 hips) according to the inclusion criteria. A retrospective study of 51 patients with M RI and X ray radiographs after internal fixation of femoral neck fractures in young and middle-aged patients was conducted from 3 to 6 months after operation. There were 16 patients with femoral neck fractures from 7 months to 12 months and 9 patients from 13 to 20 months after operation. The clinical data of 5 patients with 鈮，
本文编号：2247190
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