摘要目的 评估7.5 mm QWIX螺钉治疗股骨颈骨折的临床疗效并分析术后股骨头缺血坏死的危险因素. 方法 2009年1月-2012年3月收治股骨颈骨折患者53例,行闭合或者切开复位直径7.5 mm QWIX螺钉固定.术后随访股骨颈骨折愈合情况、内固定相关并发症、患侧髋关节Harris评分、股骨头缺血坏死等,并对患者的年龄、性别、致伤原因、骨折类型、术前等待时间、复位方式及骨折复位情况等资料进行单因素分析和多因素Logistic回归分析. 结果 所有患者均获得随访2～5年(平均3.4年).所有股骨颈骨折均达到骨性愈合,无螺钉退出、切出股骨头或进入关节腔内.术后2年平均Harris评分为91.2分(68～ 100分),其中优42例,良6例,中1例,差4例,优良率为91％.术后12 ～ 15个月,4例发生股骨头缺血坏死,坏死率为8％.Logistic回归分析发现股骨头缺血坏死与骨折解剖部位分型相关(OR =25.208,P ＜0.01). 结论 直径7.5 mm QWIX螺钉治疗股骨颈骨折具有固定稳定,骨折愈合率高、股骨头缺血坏死发生率低等优点,是治疗股骨颈骨折的良好内固定装置.股骨颈骨折术后股骨头缺血坏死与其解剖分型有关.

abstractsObjective To evaluate the clinical effect of femoral neck fracture fixed with 7.5mm QWIX screws and to find out risk factors for avascular necrosis of the femoral head postoperatively.Methods From January 2009 and March 2013, 53 patients underwent closed or open reduction of femoral neck fracture with 7.5mm QWIX screws.Healing process of fracture, complications of internal fixation, Harris hip score and avascular necrosis of the femoral head were followed up.The data reviewed were age, gender, injury patterns, fracture type, preoperative waiting time, reduction ways, reduction condition, and others.Unilateral and multivariate Logistic analysis were applied to identify factors for avascular necrosis of the femoral head.Results All patients were followed up for 2-5 years (mean, 3.4 years).There was no non-union at follow-up, and all the screws were in the original site without loosening, cut-out or penetration.Mean Harris score was 91.2 points (range, 68 to 100 points) 2 years after operation, including 42 excellent, 6 good, 1 fair and 4 poor results with the excellent-good rate of 91％.Four patients (8％) had avascular necrosis 12 to 15 months after operation.With Logistic regression analysis, fracture anatomic type was identified as the only factor for avascular necrosis of the femoral head.Conclusions The 7.5 mm QWIX fixation screw provides rigid fixation, high healing rate and low incidence of avascular necrosis of the femoral head, appearing to be a good hardware to repair femoral neck fracture.Avascular necrosis of the femoral head is associated with the anatomic type of femoral neck fracture after operation.