[1]柳松,张德祥.老年股骨转子间骨折患者股骨近端防旋髓内钉内固定术后颈干角丢失的影响因素分析[J].中医正骨,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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老年股骨转子间骨折患者股骨近端防旋髓内钉内固定术后颈干角丢失的影响因素分析()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期数:
2023年11期
页码:
5-9
栏目:
临床研究
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; 张德祥
资阳市第一人民医院,四川 资阳 641300
Author(s):
LIU Song; ZHANG Dexiang
The First People's Hospital of Ziyang,Ziyang 641300,Sichuan,China
关键词:
髋骨折;  股骨转子间骨折;  股骨近端防旋髓内钉;  股骨颈干角;  骨质疏松
Keywords:
hip fractures;  femoral intertrochanteric fracture;  proximal femoral nail antirotation;  collodiaphyseal angle of the femur;  osteoporosis
摘要:
目的:探究老年股骨转子间骨折患者股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定术后颈干角丢失的影响因素。方法:选取2019年8月至2021年10月采用PFNA内固定术治疗的单侧闭合性股骨转子间骨折患者为研究对象,从病历系统中提取数据,包括年龄、性别、体质量指数、基础疾病、Evans分型、骨折原因、受伤至手术时间、术前长期卧床情况、骨质疏松程度、术前抗骨质疏松治疗情况、Singh指数、股骨近端外侧壁厚度、手术至下地负重时间。术后1年颈干角与术中纠正后颈干角差值≥10°即判定为颈干角丢失,按颈干角是否丢失将患者分为丢失组和未丢失组。先对2组患者的相关信息进行比较,然后将组间差异有统计学意义的因素作为自变量,将术后颈干角丢失情况作为因变量,进行Logistic多因素回归分析。结果:共纳入118例患者,丢失组21例、未丢失组97例。2组患者合并糖尿病情况、术前长期卧床情况、Singh指数、骨质疏松程度、术前抗骨质疏松治疗情况、股骨近端外侧壁厚度的组间差异均有统计学意义,其余各因素的组间差异均无统计学意义。Logistic多因素回归分析结果显示,合并骨质疏松症、Singh指数1～3级、术前未抗骨质疏松治疗均为老年股骨转子间骨折患者PFNA内固定术后颈干角丢失的危险因素[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)],股骨近端外侧壁厚度为保护因素[B=-0.214,P=0.002,OR=0.807,95%CI(0.736,0.964)]。结论:合并骨质疏松症、Singh指数1～3级、术前未抗骨质疏松治疗、股骨近端外侧壁厚度偏小均可导致老年股骨转子间骨折患者PFNA内固定术后颈干角丢失风险增加。
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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