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[1]翟亞業(yè),秦曉彬,李森,等.老年股骨轉(zhuǎn)子間骨折股骨近端防旋髓內(nèi)釘內(nèi)固定術(shù)后髖關(guān)節(jié)功能恢復(fù)的影響因素分析[J].中醫(yī)正骨,2022,34(12):29-35.
　ZHAI Yaye,QIN Xiaobin,LI Sen,et al.Factors affecting hip functional recovery in the elderly with intertrochanteric fractures treated with proximal femoral nail antirotation internal fixation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(12):29-35.
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老年股骨轉(zhuǎn)子間骨折股骨近端防旋髓內(nèi)釘內(nèi)固定術(shù)后髖關(guān)節(jié)功能恢復(fù)的影響因素分析()
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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12期
頁碼:
29-35
欄目:
臨床研究
出版日期:
2022-12-02

文章信息/Info

Title:
Factors affecting hip functional recovery in the elderly with intertrochanteric fractures treated with proximal femoral nail antirotation internal fixation
作者:
翟亞業(yè); 秦曉彬; 李森; 李含; 孫秀欽; 張超遠; 葉向陽
(南陽市中心醫(yī)院,河南 南陽 473003)
Author(s):
ZHAI Yaye; QIN Xiaobin; LI Sen; LI Han; SUN Xiuqin; ZHANG Chaoyuan; YE Xiangyang
Nanyang Central Hospital,Nanyang 473003,Henan,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;  危險因素;  Logistic模型
Keywords:
hip fractures;  femoral intertrochanteric fracture;  aged;  fracture fixation;  internal;  proximal femoral nail antirotation;  risk factors;  logistic models
摘要:
目的:探討老年股骨轉(zhuǎn)子間骨折股骨近端防旋髓內(nèi)釘(proximal femoral nail antirotation,PFNA)內(nèi)固定術(shù)后髖關(guān)節(jié)功能恢復(fù)的影響因素。方法:收集2016年1月至2021年2月在南陽市中心醫(yī)院采用PFNA治療的老年股骨轉(zhuǎn)子間骨折患者的病例資料,包括患者的性別、年齡、合并內(nèi)科疾病、致傷原因、骨折類型、外側(cè)壁厚度、骨質(zhì)疏松程度、外側(cè)壁分型、美國麻醉醫(yī)師協(xié)會(American Society of Anesthesiologists,ASA)分級、受傷至手術(shù)時間、手術(shù)時長、骨折復(fù)位質(zhì)量、尖頂距、刀片位置、術(shù)后并發(fā)癥、術(shù)后負重情況等信息。按照末次隨訪時Harris髖關(guān)節(jié)評分將患者分為髖關(guān)節(jié)功能優(yōu)良組(Harris髖關(guān)節(jié)評分≥80分)和髖關(guān)節(jié)功能欠佳組(Harris髖關(guān)節(jié)評分<80分)。先對2組患者的相關(guān)信息進行單因素對比分析,再將其中組間差異具有統(tǒng)計學(xué)意義的因素進行多因素Logistic回歸分析。采用Hosmer-Lemeshow檢驗判斷模型擬合優(yōu)劣。結(jié)果:共納入323例患者,其中255例髖關(guān)節(jié)功能恢復(fù)優(yōu)良(髖關(guān)節(jié)功能優(yōu)良組)、68例髖關(guān)節(jié)功能恢復(fù)欠佳(髖關(guān)節(jié)功能欠佳組)。2組患者的性別、合并內(nèi)科疾病、致傷原因、ASA分級、手術(shù)時長、刀片位置、術(shù)后并發(fā)癥比較,組間差異均無統(tǒng)計學(xué)意義(χ2=2.752,P=0.097; χ2=0.923,P=0.337; χ2=3.223,P=0.200; χ2=3.132,P=0.077; χ2=2.093,P=0.148; χ2=2.831,P=0.092; χ2=2.459,P=0.117); 2組患者的年齡、骨折類型、外側(cè)壁厚度、骨質(zhì)疏松程度、外側(cè)壁分型、受傷至手術(shù)時間、骨折復(fù)位質(zhì)量、尖頂距、術(shù)后負重情況比較,組間差異均有統(tǒng)計學(xué)意義(χ2=4.202,P=0.040; χ2=9.129,P=0.003; χ2=14.622,P=0.000; χ2=5.174,P=0.023; χ2=25.111,P=0.000; χ2=5.967,P=0.015; Z=-2.743,P=0.006; χ2=9.475,P=0.002; χ2=21.630,P=0.000)。Logistic回歸分析結(jié)果顯示,不穩(wěn)定性骨折、Ⅲ型外側(cè)壁、外側(cè)壁厚度≤2 cm、尖頂距>25 mm和術(shù)后延遲負重是影響老年股骨轉(zhuǎn)子間骨折PFNA內(nèi)固定術(shù)后髖關(guān)節(jié)功能恢復(fù)的主要危險因素(β=1.165,P=0.016,OR=4.206; β=1.833,P=0.000,OR=6.250; β=1.424,P=0.002,OR=4.152; β=1.026,P=0.037,OR=2.791; β=1.059,P=0.006,OR=2.884)。Hosmer-Lemeshow檢驗顯示回歸模型對數(shù)據(jù)擬合度較好(χ2=5.362,P=0.103)。結(jié)論:不穩(wěn)定性骨折、外側(cè)壁不完整、外側(cè)壁厚度≤2 cm、尖頂距>25 mm和術(shù)后延遲負重是影響老年股骨轉(zhuǎn)子間骨折PFNA術(shù)后髖關(guān)節(jié)功能恢復(fù)的主要危險因素。
Abstract:
Objective:To investigate the factors influencing the hip functional recovery in the elderly patients with intertrochanteric fractures treated with proximal femoral nail antirotation(PFNA)internal fixation.Methods:The medical records of the patients with intertrochanteric fractures treated with PFNA internal fixation in the Nanyang Central Hospital from January 2016 to February 2021 were retrospectively analyzed.The records included the information of sex,age,combined diseases,disease cause,fracture type,lateral wall thickness and typing,bone loss,American Society of Anesthesiologists(ASA)grade,time from fracture to surgery,duration of operation,fracture reduction quality,tip-apex distance,blade position,postoperative complications,and postoperative weight bearing.According to the Harris hip score at the last follow-up,the patients were assigned into a group with good hip function(Harris hip score of ≥80 points)and a group with poor hip function(Harris hip score of <80 points).Univariate analysis was carried out to compare the general data between the two groups,and then multivariate logistic regression analysis was employed to screen out the main factors affecting the recovery of hip function after surgery.Hosmer-Lemeshow test was conducted to evaluate the model fitting performance.Results:A total of 323 patients were enrolled in this study,including 255 patients in the group with good hip function and 68 patients in the group with poor hip function.Sex,combined diseases,disease cause,ASA grade,duration of operation,blade position,and postoperative complications showed no significant differences between the two groups(χ2=2.752,P=0.097; χ2=0.923,P=0.337; χ2=3.223,P=0.200; χ2=3.132,P=0.077; χ2=2.093,P=0.148; χ2=2.831,P=0.092; χ2=2.459,P=0.117).Age,fracture type,lateral wall thickness and typing,bone loss,time from fracture to surgery,fracture reduction quality,tip-apex distance,and postoperative weight bearing showed differences between the two group(χ2=4.202,P=0.040; χ2=9.129,P=0.003; χ2=14.622,P=0.000; χ2=5.174,P=0.023; χ2=25.111,P=0.000; χ2=5.967,P=0.015; Z=-2.743,P=0.006; χ2=9.475,P=0.002; χ2=21.630,P=0.000).Further multivariate regression predicted that unstable fracture,fracture of type Ⅲ,lateral wall thickness of ≤2 cm,tip-apex distance of>25 mm,and delayed weight bearing were the main factors affecting hip function after PFNA internal fixation for intertrochanteric fractures(β=1.165,P=0.016,OR=4.206; β=1.833,P=0.000,OR=6.250; β=1.424,P=0.002,OR=4.152; β=1.026,P=0.037,OR=2.791; β=1.059,P=0.006,OR=2.884).The Hosmer-Lemeshow test showed that the regression model had good fitting performance(χ2=5.362,P=0.103).Conclusion:Unstable fracture,incomplete lateral wall,lateral wall thickness of≤2 cm,tip-apex distance of>25 mm,and delayed weight bearing are independent risk factors for poor recovery of the hip function after PFNA internal fixation in the elderly patients with intertrochanteric fractures.

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(收稿日期:2022-04-14 本文編輯:時紅磊)

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備注/Memo

備注/Memo:
基金項目:河南省科技發(fā)展計劃項目(182102310466) 通訊作者:葉向陽 E-mail:[email protected]
更新日期/Last Update: 1900-01-01