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股骨粗隆间骨折股骨近端防旋髓内钉内固定失效的危险因素分析 被引量:5

Internal fixation failure following proximal femoral nail antirotation for treatment of femoral intertrochanteric fractures:analysis of risk factors
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摘要 目的探讨股骨近端防旋髓内钉内固定治疗股骨粗隆间骨折术后内固定失效的危险因素,并对其原因进行分析。方法回顾性分析自2015-06—2020-06采用股骨近端防旋髓内钉内固定治疗的149例股骨粗隆间骨折,根据术后是否出现内固定失败分为成功组与失败组,收集两组患者性别、年龄、合并内科疾病、骨质疏松程度、骨折AO分型、外侧壁厚度、外侧壁分型、骨折复位质量、螺旋刀片位置、尖顶距值,并对各项数据进行单因素分析以及多因素Logistic回归分析。结果149例术后均获得随访,随访时间平均12.5(6~18)个月。129例骨折均骨性愈合(成功组),20例出现内固定失效(失败组),其中7例螺旋刀片切出髋臼或股骨头,5例髋内翻畸形,3例螺旋刀片退出,2例骨不愈合,2例内固定物周围骨折,1例股骨颈短缩。多因素Logistic回归分析结果显示,失败组合并内科疾病患者比例明显大于成功组,侧位X线片上螺旋刀片位于后方、外侧壁分型为Ⅱ型、外侧壁厚度小显著增加内固定失效风险。结论合并内科疾病、侧位X线片上螺旋刀片置于后位、外侧壁分型为Ⅱ型、外侧壁厚度小是股骨粗隆间骨折股骨近端防旋髓内钉内固定失效的独立危险因素,术前应积极治疗患者内科疾病,术中应重建和加固外侧壁,准确置入螺旋刀片。 Objective To investigate the risk factors of internal fixation failure following proximal femoral anti-rotation intramedullary nailing(PFNA)for the treatment of femoral intertrochanteric fractures and to analyze the causes.Methods A total of 149 patients who received PFNA internal fixation from June 2015 to June 2020 were divided into success and failure groups according to whether internal fixation failure occurred after surgery.Gender,age,combined medical diseases,osteoporosis,fracture AO type,lateral femoral wall fractionation and thickness,fracture reduction quality,spiral blade position,and tip apex distance were collected from both groups.Univariate and multivariate Logistic regression analysis was performed for the above two groups of indicators.Results All 149 patients were followed up for 6 to 18 months,with an average of 12.5 months,129 fractures had healed(success group),20 patients had internal fixation failure(failure group),including 7 cases of helical blade cut out,5 cases of hip varus deformity,3 cases of spiral blade withdrawal,2 cases of bone nonunion,2 cases of fracture around the internal fixation,and 1 case of femoral neck shortening.Multifactorial logistic regression analysis showed significantly more patients in the failure group with medical diseases than in the success group,and that the posterior placement of the blade on lateral radiographs,poor integrity of lateral femoral wall,and thin thickness of lateral femoral wall cortext significantly increased the risk of internal fixation failure.Conclusion Patients with medical diseases,posterior blade position,poor integrity of lateral femoral wall and thin thickness of lateral cortex are independent risk factors for PFNA internal fixation failure.Clinicians should actively treat the patient’s medical condition,rebuild and reinforce the lateral femoral wall,and correctly place the blade.
作者 章鑫隆 陈飞 闫石 ZHANG Xin-long;CHEN Fei;YAN Shi(不详;Department of Orthopedics,the First People’s Hospital of Fuyang District,Hangzhou,Zhejiang 311400,China)
出处 《中国骨与关节损伤杂志》 2022年第12期1238-1242,共5页 Chinese Journal of Bone and Joint Injury
基金 浙江省医药卫生科研项目(2020PY066)。
关键词 股骨粗隆间骨折 股骨近端防旋髓内钉 内固定失效 危险因素分析 Femoral intertrochanteric fractures Proximal femoral nail antirotation Internal fixation failure Risk factor analysis
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