摘要
目的探讨股骨近端防旋髓内钉(PFNA)治疗老年股骨转子间不稳定骨折术后内固定失效的危险因素。方法回顾性分析应用PFNA治疗104例老年股骨转子间不稳定骨折患者资料。根据术后是否发生内固定失效情况分为内固定失效组(n=15)和成功组(n=89),以性别、年龄、基础疾病、Singh指数、骨折分型、麻醉方式、术中出血量、手术时间、尖顶距(TAD)、骨折复位质量、术后下地行走时间为变量。采用χ^2检验、Wilcoxon秩和检验和logistic回归分析。结果患者均获随访,时间6~45个月。104例中15例患者术后发生内固定失效。单因素分析显示TAD、Singh指数、骨折复位质量及基础疾病是内固定失效的危险因素。Logistic回归分析显示Singh指数、骨折复位质量及基础疾病为内固定失效的独立危险因素。结论严重骨质疏松、骨折复位不良、基础疾病状况严重及TAD≥30mm的老年股骨转子间不稳定骨折是PFNA内固定失效的高危因素,临床应予以有效干预或者采取其他治疗措施。
Objective To investigate the risk factors of proximal femoral nail antirotation(PFNA)in the treatment of unstable femoral intertrochanteric fracture in the elderly.Methods Retrospective analysis was performed in 104 cases of unstable femoral intertrochanteric fractures in the elderly.Depending on whether or not there was the failure of internal fixation,the patients were divided into failed internal fixation group(n=15)and successful group(n=89).Sex,age,basic disease,Singh index,fracture classification,operative anaesthesia,intraoperative bleeding volume,operation time,tip-apex distance(TAD),fracture reduction quality and postoperative walking time were used as analysis variables,usingχ^2 test,Wilcoxon rank sum test and logistic regression analysis.Results All patients were followed up for 6~45 months.Failure of internal fixation occurred in 15 cases of 104 patients.Univariate analysis showed that TAD,Singh index,fracture reduction quality and basic diseases were risk factors for failure of internal fixation.Logistic regression analysis showed that Singh index,fracture reduction quality and basic diseases were independent risk factors for failure of internal fixation.Conclusions Severe osteoporosis,poor fracture reduction quality,severe basic diseases,and TAD≥30 mm were the high risk factors of unstable femoral intertrochanteric fracture in the elderly.Clinical intervention should be effective or other therapeutic measures should be taken.
作者
王炜昌
王荣生
石裕明
何立文
许育东
王伟雄
任光华
WANG Wei-chang;WANG Rong-sheng;SHI Yu-ming;HE Li-wen;XU Yu-dong;WANG Wei-xiong;REN Guang-hua(Dept of Orthopaedics,the People′s Hospital of Xinyi,Xinyi,Guangdong525300,China)
出处
《临床骨科杂志》
2019年第4期477-481,共5页
Journal of Clinical Orthopaedics
关键词
内固定
股骨转子间骨折
股骨近端防旋髓内钉
SINGH指数
骨折复位质量
尖顶距
internal fixation
femoral intertrochanteric fractures
proximal femoral nail anti-rotation
Singh index
fracture reduction quality
tip-apex distance
