PauwelsⅢ型股骨颈骨折患者发生创伤性骨坏死的影响因素分析

胡冠琼; 周也立; 陈群英; 黄克伦

doi:10.16766/j.cnki.issn.1674-4152.003709

PauwelsⅢ型股骨颈骨折患者发生创伤性骨坏死的影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.003709

温州医科大学附属第一医院骨科, 浙江温州 325000

基金项目:

浙江省医药卫生科技计划项目 2023KY894

详细信息

通讯作者:
周也立，E-mail：Zhouyl_12@aliyun.com

中图分类号: R683.42
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- 文章访问数: 24
- HTML全文浏览量: 10
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2023-12-29
- 网络出版日期: 2024-12-28

Factors influencing traumatic osteonecrosis in patients with Pauwels type Ⅲ femoral neck fracture

Department of Orthopaedics, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探讨PauwelsⅢ型股骨颈骨折(FNF)患者创伤性骨坏死发生的风险，并分析影响创伤性骨坏死发生的相关因素。方法选取温州医科大学附属第一医院2019年1月—2021年7月收治的257例FNF患者为研究对象，根据末次随访的影像学检查结果将所有患者分为坏死组和非坏死组。收集所有患者一般资料以及实验室检查结果，采用多因素logistic回归分析研究影响创伤性骨坏死发生的相关因素。结果截至末次随访，21例患者脱落，236例患者纳入研究，坏死组87例(36.86%)，非坏死组149例(63.14%)；2组损伤机制、复位方式以及复位质量组间比较差异均有统计学意义(P < 0.05)；坏死组载脂蛋白A1、Ⅰ型前胶原N-端前肽(PⅠNP)、一氧化氮(NO)水平以及基质细胞衍生因子-1(CXCL12)均低于非坏死组，载脂蛋白B以及IL-33水平均高于非坏死组(P < 0.05)；多因素logistic回归分析结果显示复位质量为C、高IL-33、高载脂蛋白B是创伤性骨坏死发生的危险因素, 高CXCL12、高NO、高载脂蛋白A1是创伤性骨坏死发生的保护因素(P < 0.05)。结论 PauwelsⅢ型FNF创伤性骨坏死的发生率较高，且复位质量C、IL-33、CXCL12、NO、脂蛋白A1以及载脂蛋白B为FNF患者创伤性骨坏死发生的影响因素。
- PauwelsⅢ型股骨颈骨折 /
- 创伤性骨坏死 /
- 基质细胞衍生因子-1 /
- 手术 /
- 炎症
Abstract: Objective To explore the risk of traumatic osteonecrosis in patients with Pauwels type Ⅲ femoral neck fracture (FNF) and analyze associated factors. Methods A total of 257 cases of FNF from the First Affiliated Hospital of Wenzhou Medical University, treated from January 2019 to July 2021, were selected as the research object. According to the imaging findings of the last follow-up, all patients were divided into necrosis group and non-necrosis group. The general data and laboratory examination results of all patients were collected, and the factors affecting the development of traumatic osteonecrosis were analyzed by multivariate logistic regression. Results At the last follow-up, 21 patients had fallen out and 236 patients were included in the study. There were 87 cases (36.86%) in the necrotic group and 149 cases (63.14%) in the non-necrotic group. There were significant differences in injury mechanism, reduction mode, and reduction quality between the two groups (P < 0.05). The levels of apolipoprotein A1, procollagen Ⅰ N-terminal propeptide (PⅠNP), nitric oxide (NO), and stromal cell-derived factor-1 (CXCL12) in the necrotic group were lower than those in the non-necrotic group, while the levels of apolipoprotein B and IL-33 were higher (P < 0.05). Multivariate logistic regression analysis showed that the reduction quality of C, high IL-33 and high apolipoprotein B were risk factors for traumatic osteonecrosis, while high CXCL12, high NO and high apolipoprotein A1 were protective factors for traumatic osteonecrosis (P < 0.05). Conclusion The incidence of Pauwels type III FNF traumatic osteonecrosis is higher. Reduction quality C, IL-33, CXCL12, NO, lipoprotein A1, and apolipoprotein B were influencing factors of traumatic osteonecrosis in patients with femoral neck fracture.
- Pauwels type Ⅲ femoral neck fracture /
- Traumatic osteonecrosis /
- Stromal cell-derived factor-1 /
- Surgery /
- Inflammation

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表 1 2组股骨颈骨折患者一般资料比较

Table 1. Comparison of general data of patients with femoral neck fracture in 2 groups

项目	非坏死组(n=149)	坏死组(n=87)	统计量	P值
年龄(x±s，岁)	45.35±10.26	47.04±12.61	1.062^a	0.290
性别[例(%)]			0.043^b	0.835
男性	87(58.39)	52(59.77)
女性	62(41.61)	35(40.23)
BMI(x±s)	23.26±2.51	22.48±3.83	1.699^a	0.092
损伤机制[例(%)]			46.578^b	< 0.001
RTA	41(27.52)	60(68.96)
跌倒	84(56.37)	12(13.79)
高处坠落	24(16.11)	15(17.24)
复位方式[例(%)]			15.253^b	< 0.001
开放	47(31.54)	50(57.47)
闭合	102(68.46)	37(42.53)
骨折侧别[例(%)]			0.466^b	0.495
左侧	84(56.38)	53(60.92)
右侧	65(43.62)	34(39.08)
骨折线位置[例(%)]			0.963^b	0.618
头下	24(16.11)	13(14.94)
经颈	118(79.19)	72(82.76)
基底	7(4.70)	2(2.30)
复位质量[例(%)]			18.921^b	< 0.001
A	69(46.31)	31(35.63)
B	75(50.34)	38(43.68)
C	5(3.35)	18(20.69)
骨折至入院时间[例(%)]			0.176^b	0.675
≤3 d	78(52.35)	48(55.17)
>3 d	71(47.65)	39(44.83)
注：^a为t值，^b为χ²值。

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表 2 2组股骨颈骨折患者实验室检查结果比较(x±s)

Table 2. Comparison of laboratory results of femoral neck fracture in the 2 groups(x±s)

项目	非坏死组(n=149)	坏死组(n=87)	t值	P值
IL-33(pg/mL)	115.07±10.15	128.26±17.07	9.441	< 0.001
CXCL12(pg/mL)	308.54±51.17	262.25±61.24	6.227	< 0.001
NO(μmol/L)	11.75±3.89	6.34±2.51	11.635	< 0.001
肾功能
Cr(μmol/L)	72.62±13.65	73.81±14.47	0.622	0.535
BUN(mmol/L)	5.48±1.42	5.61±1.33	0.706	0.481
UA(mmol/L)	340.54±72.64	352.21±81.24	1.106	0.270
肝功能
AST(IU/L)	24.49±8.36	24.31±7.87	0.166	0.869
ALT(IU/L)	22.21±7.02	21.24±10.03	0.795	0.428
脂代谢
TC(mmol/L)	4.49±1.34	4.62±1.24	0.754	0.452
TG(mmol/L)	2.74±0.53	2.81±0.59	0.912	0.363
HDL-C(mmol/L)	1.31±0.36	1.29±0.29	0.467	0.641
LDL-C(mmol/L)	3.15±1.04	3.28±1.26	0.814	0.417
脂蛋白A1(g/L)	1.55±0.36	1.20±0.24	8.942	< 0.001
载脂蛋白B(g/L)	0.54±0.16	0.99±0.31	12.596	< 0.001
PⅠNP(ng/mL)	69.10±10.25	58.37±9.87	7.943	< 0.001

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表 3 PauwelsⅢ型股骨颈骨折患者发生创伤性骨坏死的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of traumatic osteonecrosis in patients with Pauwels type Ⅲ femoral neck fracture

变量	B	SE	Waldχ²	P值	OR值	95% CI
复位质量C	3.982	1.819	4.795	0.029	53.630	1.519~1 894.036
IL-33	0.265	0.101	6.821	0.009	1.303	1.068~1.590
NO	-1.059	0.354	8.944	0.003	0.347	0.173~0.694
CXCL12	-0.029	0.009	10.896	0.001	0.972	0.955~0.988
脂蛋白A1	-5.874	2.372	6.131	0.013	0.003	0.000~0.294
载脂蛋白B	4.136	1.717	5.800	0.016	62.559	2.160~1 812.059

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