摘要
目的:分析闭合复位髓内外内固定治疗老年股骨转子间骨折术后内固定失败的危险因素。方法:回顾性分析2010年1月至2017年1月采用闭合复位动力髋螺钉(dynamic hip screw,DHS)或股骨近端防旋髓内钉(proximal femoral anti-rotation nail,PFNA)固定治疗的232例老年股骨转子间骨折患者,男110例,女122例,年龄65～86(平均78.65)岁。骨折AO分型:稳定性骨折(A1.1型至A2.1型)1 4 5例,不稳定骨折(A 2. 2型至A 3. 3型) 8 7例。记录患者末次随访的髋关节Harris评分以及内固定情况,单因素和logistic回归分析可能影响内固定失败的因素。结果:截至2018年5月,215例患者完成随访,随访率为92.67%(215/232),随访时间在15～39(平均25)个月,有17例患者在随访12个月后陆续失访。232例患者中,16例(6.90%)出现内固定失败。其中DHS固定失败6例,PFNA固定失败10例。最后一次随访(17例患者随访12个月时)髋关节Harris评分为58～90(平均81.9)分,优、良、可、差分别有42,160,13和17例,优良率为87.07%。Logistic分析结果显示骨质疏松(OR=267.31,P=0.002)、尖顶距(tipdistance,TAD)>25mm(OR=341.45,P<0.001)、不稳定型骨折(OR=22.19,P=0.020)、功能复位(OR=20.82,P=0.030)以及合并内科疾病(OR=4.61,P=0.041)是髓内外内固定治疗股骨转子间骨折失败的独立危险因素。结论:骨质疏松、TAD>25 mm、不稳定型骨折、功能复位以及合并内科疾病均能引起老年股骨转子间骨折术后内固定失败,治疗期间应重视这些因素。
Objective: To analyze the risk factors for failure of internal fixation after closed reduction and internal fixation for treatment of senile intertrochanteric fracture. Methods: Retrospective analysis was performed on 232 elderly patients with intertrochanteric fracture who were treated with closed reduction dynamic hip screw (DHS) or proximal femoral anti-rotation nail (PFNA) fixation from January 2010 to January 2017. AO classification of fractures: 145 cases of stable fractures (A1.1 to A2.1) and 87 cases of unstable fractures (A2.2 to A3.3). Hip Harris scores and internal fixation status were recorded at the last follow-up, and factors that might affect the failure of internal fixation were analyzed by univariate and logistic regression analysis. Results: Till May 2018, 215 patients were followed up, with a follow-up rate of 92.67%(215/232), with a follow-up time of 15–39 months (an average of 25 months), and 17 patients were lost successively after 12 months. Of the 232 patients, 16 had internal fixation failure, with an incidence of 6.90%. There were 6 cases of DHS fixation failure and 10 cases of PFNA fixation failure. At the last follow-up (when 17 patients were followed up for 12 months), the average score of hip Harris was 81.9 points (58–90 points), with 42 cases, 160 cases, 13 cases and 17 cases of excellent, good, fair and bad, respectively, and the excellent and good rate was 87.07%. Logistic analysis results showed that osteoporosis (OR=267.31, P=0.002), tip distance (TAD)>25 mm (OR=341.45, P<0.001), unstable fracture (OR=22.19, P=0.020), functional reduction (OR=20.82, P=0.030), and combined internal and external fixation (OR=4.61, P=0.041) were independent risk factors for failure of intertrochanteric fracture of femur. Conclusion: Osteoporosis, TAD >25 mm, unstable fracture, functional reduction, and combined internal diseases can lead to failure of postoperative internal fixation for senile intertrochanteric fracture.
作者
郝光亮
李瑞
桑成林
谷铭勇
张贵春
张强
曹学成
蔡锦方
HAO Guangliang;LI Rui;SANG Chenglin;GU Mingyong;ZHANG Guichun;ZHANG Qiang;CAO Xuecheng;CAI Jinfang(Department of Bone Trauma Surgery, Ji’nan Military General Hospital, Ji’nan 250031, China)
出处
《临床与病理杂志》
2018年第12期2599-2605,共7页
Journal of Clinical and Pathological Research
关键词
股骨转子间骨折
动力髋螺钉
股骨近端防旋髓内钉
内固定失败
危险因素
intertrochanteric fracture
dynamic hip screw
intramedullary nail of proximal femur
internal fixation failed
risk factors
