[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 Yaye; QIN Xiaobin; LI Sen; LI Han; SUN Xiuqin; ZHANG Chaoyuan; YE 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; 内;  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.

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(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