Faktori rizika od ishemijske osteonekroze glave femura posle unutrašnje fiksacije višestrukim kanuliranim zavrtnjima za frakturu vrata femura tipa III po Pauelsu
Sažetak
Uvod/Cilj. Mnogobrojni faktori dovode do preloma kuka, koji je u gerijatrijskoj populaciji učestao i često razoran. Cilj rada bio je da se utvrde faktori rizika od ishemijske osteonekroze glave femura (ONGF) posle unutrašnje fiksacije višestrukim kanuliranim zavrtnjima kod bolesnika sa frakturom vrata femura (FVF) tipa III po Pauelsu. Metode. Izdvojeno je ukupno 212 bolesnika sa FVF tipa III po Pauelsu, koji su bili podvrgnuti unutrašnjoj fiksaciji pomoću kanuliranih zavrtnja od januara 2019. do septembra 2022. godine i praćeni tokom jedne godine. Na osnovu kliničkih podataka i uočene incidencije ishemijske ONGF, bolesnici su raspoređeni u dve grupe: grupu sa pojavom ishemijske ONGF (n = 30) i grupu bez pojave ishemijske ONGF (n = 182). Za analizu faktora rizika od postoperativne ishemijske ONGF korišćena je logistička regresiona analiza. Rezultati. Životno doba, indeks telesne mase (ITM), vremenski interval od povrede do operacije, period parcijalnog opterećenja težinom tela (POT) posle operacije i preoperativni dijabetes melitus (DM) značajno su se razlikovali između grupe sa pojavom ishemijske ONGF i one bez pojave ishemijske ONGF (p < 0,05), dok nije bilo značajne razlike u ostalim kliničkim podacima (p > 0,05). Rezultati logističke regresione analize ukazuju na to da su životno doba (> 55 godina), period POT posle operacije (≤ 3 meseca), ITM (≥ 24 kg/m2), vremenski interval od povrede do operacije (> 2 dana) i preoperativni DM bili nezavisni faktori rizika od nastanka posteoperativne ishemijske ONGF (p < 0,05). Zaključak. Incidencija postoperativne ishemijske ONGF može biti snižena efikasnom kontrolom sledećih faktora rizika: životnog doba, vremena od povrede do operacije, perioda POT posle operacije i prisustva preoperativnog DM.
Reference
Liu P, Zhang Y, Sun B, Chen H, Dai J, Yan L. Risk factors for femoral neck fracture in elderly population. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2021; 46(3): 272–7.
Ziesler C, Engebretsen L. Femoral neck stress fracture. Tidsskr Nor Laegeforen 2020; 140(5). (Norwegian)
Bernstein EM, Kelsey TJ, Cochran GK, Deafenbaugh BK, Kuhn KM. Femoral Neck Stress Fractures: An Updated Review. J Am Acad Orthop Surg 2022; 30(7): 302–11.
Wang Y, Ma JX, Yin T, Han Z, Cui SS, Liu ZP, et al. Correla-tion Between Reduction Quality of Femoral Neck Fracture and Femoral Head Necrosis Based on Biomechanics. Orthop Surg 2019; 11(2): 318–24.
Zhao D, Zhang F, Wang B, Liu B, Li L, Kim SY, et al. Guide-lines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults (2019 version). J Orthop Translat 2020; 21: 100–10.
Bastard C. Femoral neck fracture. Rev Prat 2019; 69(10): 1124–8. (French)
Konarski W, Poboży T, Śliwczyński A, Kotela I, Krakowiak J, Hordowicz M, et al. Avascular Necrosis of Femoral Head-Overview and Current State of the Art. Int J Environ Res Public Health 2022; 19(12): 7348.
Steele CE, Cochran G, Renninger C, Deafenbaugh B, Kuhn KM. Femoral Neck Stress Fractures: MRI Risk Factors for Progres-sion. J Bone Joint Surg Am 2018; 100(17): 1496–502.
Su Z, Liang L, Hao Y. Medial femoral plate with cannulated screw for Pauwels type III femoral neck fracture: A meta-analysis. J Back Musculoskelet Rehabil 2021; 34(2): 169–77.
Lim EJ, Shon HC, Cho JW, Oh JK, Kim J, Kim CH. Dynamic Hip Screw versus Cannulated Cancellous Screw in Pauwels Type II or Type III Femoral Neck Fracture: A Systematic Re-view and Meta-Analysis. J Pers Med 2021; 11(10): 1017.
Gao Z, Wang M, Shen B, Chu X, Ruan D. Treatment of Pau-wels type III femoral neck fracture with medial femoral neck support screw: a biomechanical and clinical study. Sci Rep 2021; 11(1): 21418.
Teng Y, Zhang Y, Guo C. Finite element analysis of femoral neck system in the treatment of Pauwels type III femoral neck fracture. Medicine (Baltimore) 2022; 101(28): e29450.
Xu JL, Liang ZR, Xiong BL, Zou QZ, Lin TY, Yang P, et al. Risk factors associated with osteonecrosis of femoral head af-ter internal fixation of femoral neck fracture: a systematic re-view and meta-analysis. BMC Musculoskelet Disord 2019; 20(1): 632.
Wang W, Li Y, Xiong Z, Guo Y, Li M, Mei H, et al. Effect of the Number, Size, and Location of Cannulated Screws on the Incidence of Avascular Necrosis of the Femoral Head in Pedi-atric Femoral Neck Fractures: A Review of 153 Cases. J Pedi-atr Orthop 2022; 42(3): 149–57.
Kim CH, Kim JW. A recent update on the fixation techniques for femoral neck fractures: A narrative review. J Clin Orthop Trauma 2024; 54: 102497.
Zhao C, Kan J, Xu Z, Zhao D, Lu A, Liu Y, et al. Higher BMI and lower femoral neck strength in males with type 2 diabetes mellitus and normal bone mineral density. Am J Med Sci 2022; 364(5): 631–7.
Trauma Orthopedics Group, Orthopedics Branch, Chinese Medical Association, Fixation and Limb Reconstruction Group, Orthopedics Branch, Chinese Medical Association. Expert consensus on weight bearing after lower limb fractures. Chin J Orthop Trauma 2023; 25(2): 93–100.
Yuan KX, Yang F, Fu K, Zhu DY, Jiang CY, Jin DX, et al. In-ternal fixation using fully threaded cannulated compression screws for fresh femoral neck fractures in adults. J Orthop Surg Res 2022; 17(1): 108.
Lai SW, Lin CL, Liao KF. Real-world database examining the association between avascular necrosis of the femoral head and diabetes in Taiwan. Diabetes Care 2019; 42(1): 39–43