DOI: 10.66106/jizhav.20250202 ISSN: 3105-6911

GardenⅢ、Ⅳ型股骨颈骨折术后股骨头坏死的影响因素及预测分析（Risk Factors and Predictive Analysis of Femoral Head Necrosis After Surgery for Garden Type Ⅲ and Ⅳ Femoral Neck Fractures）

闫雪松 Xuesong Yan, 张永先 Yongxian Zhang, 李家威 Jiawei Li, 范志鹏 Zhipeng Fan, 吴卓航 Zhuohang Wu
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Abstract：objective To investigate the risk factors of femoral head necrosis following closed reduction and internal fixation for Garden type Ⅲ and Ⅳ femoral neck fractures, and to establish a nomogram model for evaluating its predictive value.Methods A retrospective case-control study was performed, including 374 patients with Garden type Ⅲ and Ⅳ femoral neck fractures treated in our hospital from January 2008 to December 2020 (108 in the necrosis group and 266 in the non-necrosis group). All patients underwent closed reduction and internal fixation with CCS or DHS. Baseline data were collected preoperatively and postoperatively. Femoral head necrosis was diagnosed by follow-up (>3 years) and imaging examinations. Binary logistic regression was used to analyze the influencing factors of femoral head necrosis, based on which a predictive nomogram was established. The predictive performance of the model was evaluated by ROC curve, calibration curve and decision curve analysis (DCA).Results Among the 374 included patients, the incidence of postoperative femoral head necrosis was 28.9% (108/374). Multivariate logistic regression identified smoking, Garden index, anatomical classification, time from injury to surgery, Pauwels angle, BMI and operation duration as independent risk factors for femoral head necrosis (P<0.05). The nomogram model showed favorable predictive performance: the AUC was 0.874 with good discrimination; the calibration curve was close to the ideal line with satisfactory fitness; DCA revealed that the model achieved favorable clinical net benefit within a wide range of threshold probabilities.Conclusion This study identifies the independent risk factors for femoral head necrosis after surgery for Garden type Ⅲ and Ⅳ femoral neck fractures. The established nomogram allows individualized risk prediction in clinical practice, which is of great significance for reducing the incidence of femoral head necrosis and improving patient prognosis through early intervention of modifiable risk factors.

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