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[1]柳松,張德祥.老年股骨轉(zhuǎn)子間骨折患者股骨近端防旋髓內(nèi)釘內(nèi)固定術(shù)后頸干角丟失的影響因素分析[J].中醫(yī)正骨,2023,35(11):5-9.
　LIU Song,ZHANG Dexiang.Analysis of factors influencing the loss of collodiaphyseal angle after internal fixation with proximal femoral nail antirotation for treatment of intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(11):5-9.
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老年股骨轉(zhuǎn)子間骨折患者股骨近端防旋髓內(nèi)釘內(nèi)固定術(shù)后頸干角丟失的影響因素分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期數(shù):
2023年11期
頁碼:
5-9
欄目:
臨床研究
出版日期:
2023-11-20

文章信息/Info

Title:
Analysis of factors influencing the loss of collodiaphyseal angle after internal fixation with proximal femoral nail antirotation for treatment of intertrochanteric fractures in the aged
作者:
柳松; 張德祥
資陽市第一人民醫(yī)院,四川 資陽 641300
Author(s):
LIU Song; ZHANG Dexiang
The First People's Hospital of Ziyang,Ziyang 641300,Sichuan,China
關(guān)鍵詞:
髖骨折;  股骨轉(zhuǎn)子間骨折;  股骨近端防旋髓內(nèi)釘;  股骨頸干角;  骨質(zhì)疏松
Keywords:
hip fractures;  femoral intertrochanteric fracture;  proximal femoral nail antirotation;  collodiaphyseal angle of the femur;  osteoporosis
摘要:
目的:探究老年股骨轉(zhuǎn)子間骨折患者股骨近端防旋髓內(nèi)釘(proximal femoral nail antirotation,PFNA)內(nèi)固定術(shù)后頸干角丟失的影響因素。方法:選取2019年8月至2021年10月采用PFNA內(nèi)固定術(shù)治療的單側(cè)閉合性股骨轉(zhuǎn)子間骨折患者為研究對象,從病歷系統(tǒng)中提取數(shù)據(jù),包括年齡、性別、體質(zhì)量指數(shù)、基礎(chǔ)疾病、Evans分型、骨折原因、受傷至手術(shù)時間、術(shù)前長期臥床情況、骨質(zhì)疏松程度、術(shù)前抗骨質(zhì)疏松治療情況、Singh指數(shù)、股骨近端外側(cè)壁厚度、手術(shù)至下地負(fù)重時間。術(shù)后1年頸干角與術(shù)中糾正后頸干角差值≥10°即判定為頸干角丟失,按頸干角是否丟失將患者分為丟失組和未丟失組。先對2組患者的相關(guān)信息進(jìn)行比較,然后將組間差異有統(tǒng)計學(xué)意義的因素作為自變量,將術(shù)后頸干角丟失情況作為因變量,進(jìn)行Logistic多因素回歸分析。結(jié)果:共納入118例患者,丟失組21例、未丟失組97例。2組患者合并糖尿病情況、術(shù)前長期臥床情況、Singh指數(shù)、骨質(zhì)疏松程度、術(shù)前抗骨質(zhì)疏松治療情況、股骨近端外側(cè)壁厚度的組間差異均有統(tǒng)計學(xué)意義,其余各因素的組間差異均無統(tǒng)計學(xué)意義。Logistic多因素回歸分析結(jié)果顯示,合并骨質(zhì)疏松癥、Singh指數(shù)1～3級、術(shù)前未抗骨質(zhì)疏松治療均為老年股骨轉(zhuǎn)子間骨折患者PFNA內(nèi)固定術(shù)后頸干角丟失的危險因素[B=0.349,P=0.007,OR=1.148,95%CI(1.313,1.571); B=0.515,P=0.001,OR=1.673,95%CI(1.463,1.814); B=0.218,P=0.015,OR=1.243,95%CI(1.052,1.529)],股骨近端外側(cè)壁厚度為保護(hù)因素[B=-0.214,P=0.002,OR=0.807,95%CI(0.736,0.964)]。結(jié)論:合并骨質(zhì)疏松癥、Singh指數(shù)1～3級、術(shù)前未抗骨質(zhì)疏松治療、股骨近端外側(cè)壁厚度偏小均可導(dǎo)致老年股骨轉(zhuǎn)子間骨折患者PFNA內(nèi)固定術(shù)后頸干角丟失風(fēng)險增加。
Abstract:
Objective:To explore the factors influencing the collodiaphyseal angle(CDA)loss after internal fixation with proximal femoral nail antirotation(PFNA)in aged patients with intertrochanteric fractures.Methods:The patients who underwent PFNA internal fixation for unilateral closed intertrochanteric fractures from August 2019 to October 2021 were selected as the subjects.The information,including age,gender,body mass index,underlying diseases,Evans classification,cause of fracture,time from injury to surgery,preoperative long-term bedridden condition,degree of osteoporosis(OP),preoperative anti-osteoporosis treatment condition,Singh's index,lateral wall thickness of proximal femur and time from surgery to weight-bearing walking,was extracted from the Electronic Medical Record System(EMRS).The difference between the CDA measured at postoperative month 12 and the CDA corrected during the surgery of≥10 degrees was determined as CDA loss,and the patients were divided into loss group and non-loss group according to whether the CDA was lost.The relevant information of patients was compared between the 2 groups firstly,then the multi-factor logistic regression analysis was conducted by taking the factors with significant differences between the 2 groups as independent variable,and whether the CDA was lost as dependent variable respectively.Results:One hundred and eighteen patients were enrolled in the study,21 ones in loss group,and 97 ones in non-loss group.The differences were statistically significant between the 2 groups in combined diabetes mellitus,preoperative long-term bedridden condition,Singh's index,degree of OP,preoperative anti-osteoporosis treatment condition and lateral wall thickness of proximal femur,while,were not statistically significant in the rest factors.The results of multi-factor logistic regression analysis showed that combined OP,Singh's index graded from 1 to 3 and no preoperative anti-osteoporosis treatment were the risk factors for CDA loss in aged patients who underwent PFNA internal fixation for intertrochanteric fractures(B=0.349,P=0.007,OR=1.148,95%CI(1.313,1.571); B=0.515,P=0.001,OR=1.673,95%CI(1.463,1.814); B=0.218,P=0.015,OR=1.243,95%CI(1.052,1.529),while the lateral wall thickness of proximal femur acted as a protective factor(B=-0.214,P=0.002,OR=0.807,95%CI(0.736,0.964)).Conclusion:Combined OP,Singh's index graded from 1 to 3,no preoperative anti-osteoporosis treatment and a thin lateral wall of proximal femur can increase the risk of CDA loss after PFNA internal fixation in aged patients with intertrochanteric fractures.

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