摘要
[目的]探讨股骨近端防旋髓内钉(PFNA)内固定治疗股骨粗隆间骨折术后发生内固定失败的相关危险因素。[方法]回顾性分析2013年1月~2017年6月本院采用PFNA内固定治疗,且随访资料完整的184例患者。按随访过程中是否发生内固定失败,将患者分为两组,比较两组间各因素的差异,并行逻辑回归分析导致内固定失败的危险因素。[结果] 184例患者随访18~24个月,平均(21.10±2.15)个月。随访过程中,32例发生内固定失败,占17.39%,其余152例内固定成功,占82.61%。两组在性别构成、年龄、侧位对位差和刀片区域的差异无统计学意义(P>0.05)。但是,失败组不稳定性骨折比率显著高于成功组(P<0.05),失败组外侧壁厚度显著小于成功组(P<0.05),失败组正位对位差显著大于成功组(P<0.05),失败组的Singh指数骨质疏松程度显著重于成功组(P<0.05),失败组的尖顶距显著大于成功组(P<0.05),失败组外侧壁完整性显著差于成功组(P<0.05)。逻辑回归分析结果表明:不稳定型骨折(OR=8.299,P=0.044)、外侧壁厚度小(OR=1 010.867,P=0.001)、骨质疏松程度重(OR=6.453,P=0.023)、尖顶距大(OR=2.846,P=0.026)、外侧壁完整性差(OR=8.678,P=0.025)是内固定失败的危险因素。[结论]不稳定型骨折、外侧壁厚度小,骨质疏松程度重、尖顶距大和外侧壁完整性差是老年股骨粗隆间骨折PFNA内固定失败的危险因素。
[Objective] To explore the risk factors of proximal femoral nail anti-rotation(PFNA) failure for femoral intertro-chanteric fractures in the elderly. [Methods] A retrospective study was conducted on 184 patients who received PFNA for inter-trochanteric fractures from January 2013 to June 2017. Based on whether or not internal fixation failures happened during the follow-up period, the patients were divided into two groups. The clinical documentations were compared between the two groups, and a multiple logistic regression analysis was conducted to search the risk factors related to internal fixation failure.[Results] All the patients were followed up for 18~24 months with an average of(21.10±2.15) months. During the follow up period, 32 patients got failed internal fixation, accounted for17.39%, while the remaining 152 patients had successful internal fixation, accounted for 82.61%. Compared the failed group with the non-failed group, there were no significant differences regarding to gender, age, deviation of lateral alignment and the blade position between the two groups(P>0.05). However, the failed group had significantly higher ratio of unstable fracture, less thickness of lateral cortex, greater deviation of anteroposterior alignment, severer osteoporosis in Singh index, greater tip apex distance and poorer integrity of lateral wall than the non-failed group(P<0.05). As results of multiple logistic regression analysis, unstable fracture(OR=8.299, P=0.044), thin thickness of lateral cortex(OR=1 010.867, P=0.001), sever osteoporosis in Singh index(OR=6.453, P=0.023), great tip apex distance(OR=2.846, P=0.026) and poor integrity of lateral wall(OR=8.678, P=0.025) were the risk factors of PFNA failure.[Conclusion] The unstable fracture, thin thickness of lateral cortex, sever osteoporosis in Singh index, great tip apex distance and poor integrity of lateral wall are the risk factors of PFNA failure for femoral intertrochanteric fracture in the elderly.
作者
周钰卓
齐宇新
马腾洋
王志
康治林
李珂
王维山
史晨辉
ZHOU Yuzhuo;QI Yu-xin;MA Teng-yang;WANG Zhi;KANG Zhi-lin;LI Ke;WANG Wei-shan;SHI Chen-hui(Orthopedic Center,The First Affiliated Hospital,Medical College,Shihezi University,Shihezi 832000,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2020年第4期292-296,共5页
Orthopedic Journal of China
基金
国家自然科学基金面上项目(编号:81772407)
国家自然科学基金项目(编号:81660374,81760404)。
