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[1]張雨,李鈞,李志民,等.股骨近端防旋髓內(nèi)釘內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折內(nèi)固定失效的危險(xiǎn)因素分析[J].中醫(yī)正骨,2022,34(02):3-6.
　ZHANG Yu,LI Jun,LI Zhimin,et al.Analysis of risk factors for the failure of internal fixation with proximal femoral nail antirotation for treatment of intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(02):3-6.
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股骨近端防旋髓內(nèi)釘內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折內(nèi)固定失效的危險(xiǎn)因素分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年02期
頁(yè)碼:
3-6
欄目:
臨床研究
出版日期:
2022-02-20

文章信息/Info

Title:
Analysis of risk factors for the failure of internal fixation with proximal femoral nail antirotation for treatment of intertrochanteric fractures in the aged
作者:
張雨; 李鈞; 李志民; 黃鶴; 水明斌
浙江新安國(guó)際醫(yī)院,浙江 嘉興 314000
Author(s):
ZHANG Yu; LI Jun; LI Zhimin; HUANG He; SHUI Mingbin
Zhejiang Xin'an International Hospital,Jiaxing 314000,Zhejiang,China
關(guān)鍵詞:
髖骨折;  股骨轉(zhuǎn)子間骨折;  老年人;  骨折固定術(shù); 內(nèi);  股骨近端防旋髓內(nèi)釘;  內(nèi)固定失效;  危險(xiǎn)因素
Keywords:
hip fractures;  femoral intertrochanteric fracture;  aged;  fracture fixation; internal;  proximal femoral nail antirotation;  failed internal fixation;  risk factors
摘要:
目的:探討股骨近端防旋髓內(nèi)釘(proximal femoral nail antirotation,PFNA)內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折內(nèi)固定失效的危險(xiǎn)因素。方法:選取采用PFNA內(nèi)固定治療的100例老年股骨轉(zhuǎn)子間骨折患者的病例資料,從病歷系統(tǒng)中提取患者的性別、年齡、致傷原因、合并基礎(chǔ)疾病、骨折分型、麻醉方式、手術(shù)時(shí)間、術(shù)中出血量及并發(fā)癥發(fā)生情況等信息,并提取患者術(shù)后1個(gè)月的正側(cè)位X線片,評(píng)估患者骨折復(fù)位質(zhì)量并測(cè)量尖頂距。將發(fā)生內(nèi)固定物斷裂、術(shù)后6個(gè)月骨折不愈合、螺旋刀片松動(dòng)退出或切割股骨頭頸部等1種及以上并發(fā)癥的患者納入內(nèi)固定失效組,將未發(fā)生上述并發(fā)癥的患者納入內(nèi)固定有效組。先對(duì)2組患者的相關(guān)信息進(jìn)行單因素對(duì)比分析,然后將其中組間差異具有統(tǒng)計(jì)學(xué)意義的因素作為自變量,將內(nèi)固定是否有效作為因變量,進(jìn)行多因素Logistic回歸分析。結(jié)果:內(nèi)固定有效組納入79例,內(nèi)固定失效組納入21例。2組患者的合并基礎(chǔ)疾病、骨折分型、骨折復(fù)位質(zhì)量、尖頂距比較,組間差異均有統(tǒng)計(jì)學(xué)意義(χ2=55.598,P=0.000; χ2=14.731,P=0.000; Z=-6.162,P=0.000; χ2=46.296,P=0.000); 2組患者的性別、年齡、致傷原因、麻醉方式、手術(shù)時(shí)間、術(shù)中出血量比較,組間差異均無(wú)統(tǒng)計(jì)學(xué)意義(χ2=3.320,P=0.068; χ2=0.073,P=0.964; χ2=0.485,P=0.785; χ2=0.392,P=0.822; χ2=0.705,P=0.401; χ2=0.436,P=0.509)。Logistic回歸分析結(jié)果顯示,合并2種及以上基礎(chǔ)疾病、不穩(wěn)定型骨折、骨折復(fù)位質(zhì)量差及尖頂距≥30 mm是PFNA內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折內(nèi)固定失效的危險(xiǎn)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)。結(jié)論:合并2種及以上基礎(chǔ)疾病、不穩(wěn)定型骨折、骨折復(fù)位質(zhì)量差及尖頂距≥30 mm是PFNA內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折內(nèi)固定失效的危險(xiǎn)因素。
Abstract:
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(χ2=55.598,P=0.000; χ2=14.731,P=0.000; Z=-6.162,P=0.000; χ2=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(χ2=3.320,P=0.068; χ2=0.073,P=0.964; χ2=0.485,P=0.785; χ2=0.392,P=0.822; χ2=0.705,P=0.401; χ2=0.436,P=0.509).The results of logistic regression analysis revealed that the combination of two or more underlying diseases,unstable ITFs,unsatisfactory reduction of ITFs and TAD of ≥30 mm were the risk factors for the failure of internal fixation with PFNA in treatment of ITFs in the aged(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).Conclusion:Combination of two or more underlying diseases,unstable ITFs,unsatisfactory reduction of ITFs and TAD of ≥30 mm are the risk factors for the failure of internal fixation with PFNA in treatment of ITFs in the aged.

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通訊作者:水明斌 E-mail:[email protected]
更新日期/Last Update: 2022-02-20