[1]翟亚业,秦晓彬,李森,等.老年股骨转子间骨折股骨近端防旋髓内钉内固定术后髋关节功能恢复的影响因素分析[J].中医正骨,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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老年股骨转子间骨折股骨近端防旋髓内钉内固定术后髋关节功能恢复的影响因素分析()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年12期
页码:
29-35
栏目:
临床研究
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:
翟亚业秦晓彬李森李含孙秀钦张超远叶向阳
(南阳市中心医院,河南 南阳 473003)
Author(s):
ZHAI YayeQIN XiaobinLI SenLI HanSUN XiuqinZHANG ChaoyuanYE Xiangyang
Nanyang Central Hospital,Nanyang 473003,Henan,China
关键词:
髋骨折 股骨转子间骨折 老年人 骨折固定术 股骨近端防旋髓内钉 危险因素 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:探讨老年股骨转子间骨折股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定术后髋关节功能恢复的影响因素。方法:收集2016年1月至2021年2月在南阳市中心医院采用PFNA治疗的老年股骨转子间骨折患者的病例资料,包括患者的性别、年龄、合并内科疾病、致伤原因、骨折类型、外侧壁厚度、骨质疏松程度、外侧壁分型、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、受伤至手术时间、手术时长、骨折复位质量、尖顶距、刀片位置、术后并发症、术后负重情况等信息。按照末次随访时Harris髋关节评分将患者分为髋关节功能优良组(Harris髋关节评分≥80分)和髋关节功能欠佳组(Harris髋关节评分<80分)。先对2组患者的相关信息进行单因素对比分析,再将其中组间差异具有统计学意义的因素进行多因素Logistic回归分析。采用Hosmer-Lemeshow检验判断模型拟合优劣。结果:共纳入323例患者,其中255例髋关节功能恢复优良(髋关节功能优良组)、68例髋关节功能恢复欠佳(髋关节功能欠佳组)。2组患者的性别、合并内科疾病、致伤原因、ASA分级、手术时长、刀片位置、术后并发症比较,组间差异均无统计学意义(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组患者的年龄、骨折类型、外侧壁厚度、骨质疏松程度、外侧壁分型、受伤至手术时间、骨折复位质量、尖顶距、术后负重情况比较,组间差异均有统计学意义(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回归分析结果显示,不稳定性骨折、Ⅲ型外侧壁、外侧壁厚度≤2 cm、尖顶距>25 mm和术后延迟负重是影响老年股骨转子间骨折PFNA内固定术后髋关节功能恢复的主要危险因素(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检验显示回归模型对数据拟合度较好(χ2=5.362,P=0.103)。结论:不稳定性骨折、外侧壁不完整、外侧壁厚度≤2 cm、尖顶距>25 mm和术后延迟负重是影响老年股骨转子间骨折PFNA术后髋关节功能恢复的主要危险因素。
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.

参考文献/References:

[1] ZHANG Z,QIU Y,ZHANG Y,et al.Global trends in intertrochanteric hip fracture research from 2001 to 2020:a bibliometric and visualized study[J].Front Surg,2021,8:756614.
[2] 王正安,游镇君,蒋毅.快速康复外科理念在老年股骨转子间骨折围手术期治疗中的应用[J].中医正骨,2019,31(11):17-20.
[3] 江涛,江林,史俊德,等.多功能牵引床骨牵引治疗高龄股骨转子间骨折[J].中医正骨,2020,32(7):51-54.
[4] DE VIRGILIO-SALGADO L G,OLIVELLA G,RUBERTÉ H,et al.Effect of nonsurgical versus surgical management on geriatric hip fracture mortality of hispanic-american male veterans[J/OL].Geriatr Orthop Surg Rehabil,2021,12[2022-03-21].https://pubmed.ncbi.nlm.nih.gov/34616587/.
[5] WU H,LI Y,TONG L,et al.Worldwide research tendency and hotspots on hip fracture:a 20-year bibliometric analysis[J].Arch Osteoporos,2021,16(1):73.
[6] YUAN G X,SHEN Y H,CHEN B,et al.Biomechanical comparison of internal fixations in osteoporotic intertrochanteric fracture.A finite element analysis[J].Saudi Med J,2012,33(7):732-739.
[7] 张雨,李钧,李志民,等.解剖型髓内钉内固定和股骨近端防旋髓内钉内固定治疗老年股骨转子间骨折的比较研究[J].中医正骨,2022,34(3):15-19.
[8] ZENG C,WANG Y R,WEI J,et al.Treatment of trochanteric fractures with proximal femoral nail antirotation or dynamic hip screw systems:a meta-analysis[J].J Int Med Res,2012,40(3):839-851.
[9] SHEN Q H,BAIK J,WON Y.Assessment of the bone mineral density and microstructure of the human femoral head according to different tip-apex distances can guide the treatment of intertrochanteric hip fractures[J].Hip Pelvis,2021,33(4):190-199.
[10] LENGUERRAND E,WHITEHOUSE M R,BESWICK A D,et al.Risk factors associated with revision for prosthetic joint infection following knee replacement: an observational cohort study from England and Wales[J].Lancet Infect Dis,2019,19(6):589-600.
[11] 姜自伟,黄枫,郑晓辉,等.老年股骨粗隆间骨折术后髋关节功能恢复的影响因素[J].实用医学杂志,2010,26(22):4112-4115.
[12] 徐诗雄,洪顺红,孙文栋.老年股骨粗隆间骨折术后髋关节功能恢复的影响因素[J].中国老年学杂志,2014,34(12):3353-3355.
[13] HARRIS W H.Traumatic arthritis of the hip after dislocation and acetabular fractures:treatmentby mold arthroplasty.An end-result study using a new method of result evaluation[J].J Bone Joint Surg Am,1969,51(4):737-755.
[14] JENSEN J S,MICHAELSEN M.Trochanteric femoral fractures treated with McLaughlin osteosynthesis[J].Acta Orthop Scand,1975,46(5):795-803.
[15] GOTFRIED Y.The lateral trochanteric wall:a key element in the reconstruction of unstable pertrochanteric hip fractures[J].Clin Orthop Relat Res,2004(425):82-86.
[16] SINGH M,NAGRATH A R,MAINI P S.Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis[J].J Bone Joint Surg Am,1970,52(3):457-467.
[17] VIDYADHARA S,RAO S K.One and two femoral neck screws with intramedullary nails for unstable trochanteric fractures of femur in the elderly-randomised clinical trial[J].Injury,2007,38(7):806-814.
[18] BAUMGAERTNER M R,CURTIN S L,LINDSKOG D M.Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures[J].Clin Orthop Relat Res,1998(348):87-94.
[19] SUN D,WANG C,CHEN Y,et al.A meta-analysis comparing intramedullary with extramedullary fixations for unstable femoral intertrochanteric fractures[J].Medicine(Baltimore),2019,98(37):e17010.
[20] WANG H H,SHU W B,LAN G H,et al.Network meta-analysis of surgical treatment for unstable femoral intertrochanteric fractures[J].Oncotarget,2018,9(35):24168-24177.
[21] MU J X,XIANG S Y,MA Q Y,et al.Selection of internal fixation method for femoral intertrochanteric fractures using a finite element method[J].World J Clin Cases,2021,9(22):6343-6356.
[22] MU W,ZHOU J.PFNA-II internal fixation helps hip joint recovery and improves quality of life of patients with lateral-wall dangerous type of intertrochanteric fracture[J/OL].Biomed Res Int,2021,2021:5911868[2022-03-21].https://pubmed.ncbi.nlm.nih.gov/34859101/.
[23] SHI Z,QIANG M,JIA X,et al.Association of the lateral wall integrity with clinical outcomes in older patients with intertrochanteric hip fractures treated with the proximal femoral nail anti-rotation-Asia[J].Int Orthop,2021,45(12):3233-3242.
[24] 蒋臻,郑明军,赵小波,等.不稳定股骨粗隆间骨折PFNA-Ⅱ术后效果的影响因素分析[J].中华全科医学,2021,19(12):2016-2019.
[25] PALM H,JACOBSEN S,SONNE-HOLM S,et al.Integrity of the lateral femoral wall in intertrochanteric hip fractures:an important predictor of a reoperation[J].J Bone Joint Surg Am,2007,89(3):470-475.
[26] FAN J,XU X,ZHOU F.The lateral femoral wall thickness on the risk of post-operative lateral wall fracture in intertrochanteric fracture after DHS fixation:a finite element analysis[J].Injury,2022,53(2):346-352.
[27] 肖湘,张铁良,马宝通.“尖顶距”值与拉力螺钉切出股骨头关系的临床回顾性研究[J].中华创伤骨科杂志,2006,8(8):722-724.
[28] CARUSO G,CORRADI N,CALDARIA A,et al.New tip-apex distance and calcar-referenced tip-apex distance cut-offs may be the best predictors for cut-out risk after intramedullary fixation of proximal femur fractures[J].Sci Rep,2022,12(1):357.
[29] MOMII K,FUJIWARA T,MAE T,et al.Risk factors for excessive postoperative sliding of femoral trochanteric fracture in elderly patients:a retrospective multicenter study[J].Injury,2021,52(11):3369-3376.
[30] KEPPLER A M,PFEUFER D,KAU F,et al.Cement augmentation of the proximal femur nail antirotation(PFNA)is associated with enhanced weight-bearing in older adults[J].Injury,2021,52(10):3042-3046.
[31] SAHIN E K,IMERCI A,KINIK H,et al.Comparison of proximal femoral nail antirotation(PFNA)with AO dynamic condylar screws(DCS)for the treatment for unstable peritrochanteric femoral fractures[J].Eur J Orthop Surg Traumatol,2014,24(3):347-352.
(收稿日期:2022-04-14 本文编辑:时红磊)

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备注/Memo

备注/Memo:
基金项目:河南省科技发展计划项目(182102310466) 通讯作者:叶向阳 E-mail:yexyang2008@163.com
更新日期/Last Update: 1900-01-01