股骨近端防旋髓内钉治疗老年人股骨转子间骨折的临床疗效及相关影响因素分析

目的探讨股骨近端防旋髓内钉(proximal femoral nail antirotation, PFNA)治疗老年人股骨转子间骨折的临床疗效及相关影响因素。方法回顾性分析2013年1月至2018年1月在我院采用PFNA治疗的219例老年转子间骨折病人的临床资料,其中男93例,女126例,年龄为(76.2±8.8)岁(60~99岁);根据Evans分型标准,稳定型76例(Ⅰ型37例、Ⅱ型39例)和不稳定型143例(Ⅲ型69例、Ⅳ型51例、Ⅴ型23例)。根据术后Harris评分结果,将病人分为功能优良组(优、良)和功能欠佳组(可、差),分析比较两组病人性别、年龄、受伤原因、美国麻醉医师协会(American Society of Anesthesiologists, ASA)分级、合并内科疾病、骨折分型、骨质情况、外侧壁分型、手术时机、手术时长、骨折复位质量、尖顶距(tipapex distance, TAD)、术后并发症和术后下地负重时间等资料,并采用多因素Logistic回归模型筛选影响术后髋关节功能的主要因素。结果所有病人均获得6个月以上随访,随访时间为(16.6±9.8)个月(6~52个月),末次随访Harris评分为(85.2±8.3)分(52~96分),其中优良组161例(优89例,良72例),欠佳组58例(可39例,差19例),优良率为73.51%(161/219)。单因素分析结果显示年龄、ASA分级、骨折分型、外侧壁分型、骨质疏松、骨折复位质量、TAD和下地负重时间与髋关节功能的恢复相关(P<0.05);多因素Logistic回归分析结果显示年龄、骨折分型、外侧壁分型和下地负重时间是影响PFNA术后髋关节功能的主要因素(P<0.05)。结论 PFNA治疗老年人股骨转子间骨折的临床疗效与年龄、骨折稳定性、外侧壁完整及早期下地负重等因素直接相关。

Clinical efficacy of proximal femoral nail antirotation in the treatment of femoral intertrochanteric fractures in the elderly and its related influencing factors

Objective To explore the clinical efficacy and related influencing factors of proximal femoral nail antirotation(PFNA) in the treatment of femoral intertrochanteric fractures in the elderly.Methods The clinical data of 219 patients with femoral intertrochanteric fractures treated with PFNA between January 2013 and January 2018 were retrospectively analyzed.There were 93 males and 126 females with the age of(76.2±8.8) years old(60-99 years old).According to Evans classification,there were 76 cases of stable type(37 cases of type Ⅰ,and 39 cases of type Ⅱ) and 143 cases of unstable type(69 cases of type Ⅲ,51 cases of type Ⅳ,and 23 cases of type Ⅴ).According to Harris scores,patients were divided into two groups including excellent group with excellent function and poor group with poor function.The data of gender,age,cause of injury,American Society of Anesthesiologists(ASA) classification,medical disease,fracture classification,bone condition,external wall classification,timing of surgery,length of surgery,quality of fracture reduction,and tipapex distance(TAD),postoperative complications and postoperative bedtime between the two groups were analyzed.Multivariate Logistic regression model was used to screen the main factors affecting postoperative hip function.Results All the patients were followed up for 6 to 52 months(16.6±9.8 months).At the last followup,the Harris score was 85.2±8.3,including 161 cases in excellent group and 58 cases in poor group.The excellent rate was 73.51%(161/219).Univariate analysis showed that age,ASA classification,fracture classification,lateral wall classification,osteoporosis,quality of fracture reduction,TAD and load time of getting out of bed were associated with the recovery of hip function(P<0.05).Multivariate Logistic regression analysis showed that age,fracture classification,lateral wall classification and load time of getting out of bed were the main factors affecting the hip function after the operation of PFNA(P<0.05).Conclusion The clinical efficacy of PFNA in the treatment of femoral intertrochanteric fractures in the elderly is related to the factors such as young age,fracture stability,integrity of lateral wall and early weight bearing.