Incidence and Risk Factors of Osteonecrosis of the Femoral Head after Cephalomedullary Nailing for Pertrochanteric Fractures: Observational Single-Center Study.

IF 1.9 2区医学 Q2 ORTHOPEDICS

Clinics in Orthopedic Surgery Pub Date : 2024-06-01 Epub Date: 2024-04-22 DOI:10.4055/cios23287

Dae-Kyung Kwak, Seunghun Lee, Kang-Uk Lee, Je-Hyun Yoo

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Abstract

Background: The objective of this study was to investigate the incidence of osteonecrosis of the femoral head (ONFH) after cephalomedullary nailing in elderly patients with pertrochanteric fractures and to analyze the risk factors related to ONFH.

Methods: A total of 689 consecutive patients with cephalomedullary nailing for pertrochanteric fractures at our hospital were recruited. Of these, 368 patients who met the inclusion criteria were finally enrolled. ONFH after cephalomedullary nailing was identified by reviewing patients' electronic charts and serial radiographs. The ONFH group was then compared with the non-ONFH group.

Results: ONFH was identified in 9 of 368 patients (2.4%). The time to diagnosis of ONFH averaged 23.8 months (range, 5-54 months) after index surgery. The mean age, body mass index, and bone mineral density (T-score in femur neck) were 84.1 ± 7.1 years, 23.7 ± 3.6 kg/m², and -3.1 ± 0.7 kg/m², respectively. The times from injury to surgery, from admission to surgery, and operation time averaged 4.2 ± 2.7 days, 3.6 ± 2.6 days, and 87.2 ± 30.0 minutes, respectively. Among 9 patients, 3 underwent conversion arthroplasty. The ONFH group had advanced age (p = 0.029), more basicervical fracture components (p = 0.002), and inadequate reduction (p = 0.045) compared to the non-ONFH group. On multivariate analysis, advanced age (odds ratio [OR], 1.61;, p = 0.022), basicervical fracture components (OR, 24.58; p = 0.001), and inadequate reduction (OR, 4.11; p = 0.039) were identified as risk factors of ONFH.

Conclusions: Although ONFH is relatively rare after cephalomedullary nailing for pertrochanteric fractures in elderly patients, its risk may increase with advanced age, basicervical fracture components, and inadequate reduction. Therefore, in patients with these risk factors, meticulous and longer follow-up is needed even after bone union.

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头髓内钉治疗股骨粗隆间骨折后股骨头骨坏死的发病率和风险因素：单中心观察研究

研究背景本研究旨在调查老年股骨粗隆间骨折患者头髓内钉术后股骨头坏死（ONFH）的发生率，并分析与ONFH相关的风险因素：方法：共招募了689例在我院接受头髓内钉治疗的连续性转子前骨折患者。其中，符合纳入标准的患者有 368 例。通过查看患者的电子病历和序列X光片，确定了头髓内钉后的ONFH。然后将ONFH组与非ONFH组进行比较：结果：368 例患者中有 9 例（2.4%）被确诊为 ONFH。ONFH的平均诊断时间为指标手术后23.8个月（5-54个月）。平均年龄、体重指数和骨矿物质密度（股骨颈 T 值）分别为 84.1 ± 7.1 岁、23.7 ± 3.6 kg/m2 和 -3.1 ± 0.7 kg/m2。从受伤到手术、从入院到手术以及手术时间的平均值分别为（4.2±2.7）天、（3.6±2.6）天和（87.2±30.0）分钟。9 名患者中有 3 人接受了转换关节成形术。与非ONFH组相比，ONFH组患者的年龄偏大（p = 0.029）、基础颈骨折组件较多（p = 0.002）、复位不足（p = 0.045）。在多变量分析中，高龄（几率比[OR]，1.61；，p = 0.022）、基本颈椎骨折成分（OR，24.58；p = 0.001）和复位不足（OR，4.11；p = 0.039）被确定为ONFH的风险因素：结论：虽然老年患者头髓内钉治疗转子前骨折后出现ONFH的情况相对少见，但随着年龄的增长、基本颈骨折成分的增加以及复位不足，ONFH的风险可能会增加。因此，对于存在这些风险因素的患者，即使在骨结合后也需要进行细致和较长时间的随访。

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