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Chinese Journal of Tissue Engineering Research
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2023, Vol. 27 ›› Issue (36): 5747-5752
Correlation between three-dimensional measurement of posterior tilt of impacted femoral neck fracture and femoral head necrosis
Zhan Hongqi1, 2, 3, Ma Jianxiong2, 3, Cui Shuangshuang2, Sun Lei2, 3, Wang Ying2, 3, Bai Haohao2, 3, Ma Xinlong2, 3
1Tianjin Medical University, Tianjin 300070, China; 2Institute of Orthopedics, Tianjin Hospital, Tianjin 300050, China; 3Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin 300050, China
Contact: Ma Xinlong, Chief physician, Institute of Orthopedics, Tianjin Hospital, Tianjin 300050, China; Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin 300050, China
About author:Zhan Hongqi, Master candidate, Tianjin Medical University, Tianjin 300070, China; Institute of Orthopedics, Tianjin Hospital, Tianjin 300050, China; Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin 300050, China
the National Natural Science Foundation of China, Nos. 81572154, 81871777 (to MXL); National Natural Science Foundation of China, No. 11772226 (to MJX)
Abstract: BACKGROUND: In clinical practice, impacted femoral neck fractures are usually treated with cannulated screw internal fixation. In previous studies, the preoperative posterior tilt of the femoral head has been shown to be associated with internal fixation failure. However, there are few studies on the occurrence of femoral head necrosis after internal fixation and posterior tilt.
OBJECTIVE: To investigate the correlation between femoral head necrosis and posterior tilt measured by three-dimensional reconstruction and its risk factors after internal fixation of impacted femoral neck fractures.
METHODS: The clinical data of 150 patients with impacted femoral neck fractures admitted to Tianjin Hospital from 2016 to 2020 were retrospectively analyzed. The posterior tilt of the femoral head was measured by a three-dimensional reconstruction technique according to postoperative femoral head necrosis. The patients were divided into the necrosis group and the non-necrosis group. The clinical data were compared between the two groups using single-factor analysis. Risk factors of femoral head necrosis were analyzed by multivariate logistic regression analysis. The predictive value of posterior tilt for postoperative femoral head necrosis was assessed using receiver operating characteristic curves.
RESULTS AND CONCLUSION: (1) A total of 150 patients were followed up for 18 to 66 months (mean, 29 months) after surgery, and necrosis occurred in 20 patients (13.3%). (2) Multivariate logistic regression analysis exhibited that reduction quality grade C and posterior tilt were risk factors for femoral head necrosis. (3) Receiver operating characteristic curve analysis revealed the predictive value of posterior tilt measured in three dimensions for postoperative femoral head necrosis, with a cut-off value of 20.74°. (4) The results showed that posterior tilt and reduction quality grade C were risk factors for femur head necrosis after closed reduction and internal fixation in patients with impacted femoral neck fractures. The posterior tilt of the femoral head can be accurately measured by three-dimensional reconstruction technology. Patients with posterior tilt ≥20.74° are more likely to experience postoperative femoral head necrosis.
Key words: femoral neck fracture, femoral head necrosis, posterior tilt, fracture fixation, three-dimensional reconstruction