摘要
目的:探讨股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定治疗老年股骨转子间骨折内固定失效的危险因素。方法:选取采用PFNA内固定治疗的100例老年股骨转子间骨折患者的病例资料,从病历系统中提取患者的性别、年龄、致伤原因、合并基础疾病、骨折分型、麻醉方式、手术时间、术中出血量及并发症发生情况等信息,并提取患者术后1个月的正侧位X线片,评估患者骨折复位质量并测量尖顶距。将发生内固定物断裂、术后6个月骨折不愈合、螺旋刀片松动退出或切割股骨头颈部等1种及以上并发症的患者纳入内固定失效组,将未发生上述并发症的患者纳入内固定有效组。先对2组患者的相关信息进行单因素对比分析,然后将其中组间差异具有统计学意义的因素作为自变量,将内固定是否有效作为因变量,进行多因素Logistic回归分析。结果:内固定有效组纳入79例,内固定失效组纳入21例。2组患者的合并基础疾病、骨折分型、骨折复位质量、尖顶距比较,组间差异均有统计学意义(χ^(2)=55.598,P=0.000;χ^(2)=14.731,P=0.000;Z=-6.162,P=0.000;χ^(2)=46.296,P=0.000);2组患者的性别、年龄、致伤原因、麻醉方式、手术时间、术中出血量比较,组间差异均无统计学意义(χ^(2)=3.320,P=0.068;χ^(2)=0.073,P=0.964;χ^(2)=0.485,P=0.785;χ^(2)=0.392,P=0.822;χ^(2)=0.705,P=0.401;χ^(2)=0.436,P=0.509)。Logistic回归分析结果显示,合并2种及以上基础疾病、不稳定型骨折、骨折复位质量差及尖顶距≥30mm是PFNA内固定治疗老年股骨转子间骨折内固定失效的危险因素(β=1.596,P=0.022,OR=6.134;β=2.346,P=0.000,OR=6.228;β=1.875,P=0.010,OR=6.147;β=2.013,P=0.004,OR=5.101)。结论:合并2种及以上基础疾病、不稳定型骨折、骨折复位质量差及尖顶距≥30mm是PFNA内固定治疗老年股骨转子间骨折内固定失效的危险因素。
Objective:To explore the risk factors for the failure of internal fixation with proximal femoral nail antirotation(PFNA)in treatment of intertrochanteric fractures(ITFs)in the aged.Methods:The medical records of 100 aged patients who underwent PFNA internal fixation for treatment of ITFs were selected, and their information including gender, age, cause of injury, combined underlying diseases, fracture classification, anesthesia method, operative time, intraoperative blood loss and postoperative complications were extracted from the electronic medical record system(EMRS),and the anteroposterior and lateral X-ray films taken at 1 month after the surgery were extracted for evaluating the ITFs reduction outcome and measuring the tip-apex distance(TAD).Patients with one or more complications, such as breakage of internal fixator, fracture nonunion at 6 months after the surgery, loosening and withdrawal of spiral blade and cleaved femoral head and neck, were assigned into the ineffective internal fixation group(21 cases),and the ones without such complications into the effective internal fixation group(79 cases).Single-factor analysis was conducted on the information of patients in the 2 groups, followed by multi-factor logistic regression analysis by taking the factors with significant differences between the 2 groups as independent variable, and whether PFNA internal fixation was effective as dependent variable respectively.Results:There was statistical difference in combined underlying diseases, fracture classification, ITFs reduction outcome and TAD between the 2 groups(χ^(2)=55.598,P=0.000;χ^(2)=14.731,P=0.000;Z=-6.162,P=0.000;χ^(2)=46.296,P=0.000).There was no statistical difference in gender, age, cause of injury, anesthesia method, operative time and intraoperative blood loss between the 2 groups(χ^(2)=3.320,P=0.068;χ^(2)=0.073,P=0.964;χ^(2)=0.485,P=0.785;χ^(2)=0.392,P=0.822;χ^(2)=0.705,P=0.401;χ^(2)=0.436,P=0.509).The results of logistic regression analysis revealed that the combination of two or more
作者
张雨
李钧
李志民
黄鹤
水明斌
ZHANG Yu;LI Jun;LI Zhimin;HUANG He;SHUI Mingbin(Zhejiang Xin'an International Hospital,Jiaxing 314000,Zhejiang,China)
出处
《中医正骨》
2022年第2期3-6,共4页
The Journal of Traditional Chinese Orthopedics and Traumatology
关键词
髋骨折
股骨转子间骨折
老年人
骨折固定术
内
股骨近端防旋髓内钉
内固定失效
危险因素
hip fractures
femoral intertrochanteric fracture
aged
fracture fixation,internal
proximal femoral nail antirotation
failed internal fixation
risk factors
