不稳定股骨粗隆间骨折PFNA-Ⅱ术后效果的影响因素分析

  目的  探讨不稳定股骨粗隆间骨折PFNA-Ⅱ术后效果的影响因素。  方法  选取2016年1月—2019年1月于浙江省人民医院淳安分院行PFNA-Ⅱ的不稳定股骨粗隆间骨折患者63例，术后随访1年，根据术后髋关节Harris功能评分，分为优良组(Harris评分≥80分)和不良组(Harris评分＜80分)，对比2组患者一般资料及手术相关指标的差异，并行多因素logistic回归分析。  结果  随访过程中有1例患者失访，剩余62例患者末次随访时，42例Harris评分≥80分列为优良组，其余20例Harris评分＜80分列为不良组，术后髋关节功能不良率为32.26%(20/62)；比较2组BMI(25.31±4.63 vs. 27.96±4.72)、骨质疏松比例(47.62% vs. 85.00%)、尖顶距(24.43±1.65)mm vs. (26.84±2.18)mm]、外侧壁分型(Ⅰ~Ⅲ型，分别为61.90%、33.33%、4.76% vs. 30.00%、40.00%、30.00%)、外侧壁厚度(2.43±0.39)mm vs. (2.05±0.31)mm]，差异均有统计学意义(均P < 0.05)；多因素logistic回归分析结果显示:尖顶距、外侧壁分型、外侧壁厚度(均P＜0.05)可能是PFNA-Ⅱ术后髋关节功能的独立影响因素。  结论  尖顶距大、外侧壁完整性差及外侧壁薄是不稳定股骨粗隆间骨折PFNA-Ⅱ术后髋关节功能不良的独立危险因素。 

Analysis of influencing factors of the postoperative effect of unstable intertrochanteric fractures of PFNA-Ⅱ

  Objective  To explore the factors affecting the effect of PFNA-Ⅱ after unstable femoral intertrochanteric fractures.  Methods  A total of 63 patients with unstable femoral intertrochanteric fractures who underwent PFNA-Ⅱ at the Chun'an Branch of Zhejiang Provincial People's Hospital from January 2016 to January 2019 were followed up for 1 year. According to the Harris function score of the hip joint after surgery, the patients were divided into the good group (Harris score ≥ 80 points) and poor group (Harris score < 80 points). The differences in general information and surgery-related indicators between the two groups were compared, and multivariate logistic regression analysis was performed.  Results  During the follow-up, 1 patient was lost to follow-up. At the last follow-up of the remaining 62 patients, 42 patients with Harris score ≥ 80 were classified as the good group, and the remaining 20 patients with Harris score < 80 were classified as the poor group. The rate of postoperative hip dysfunction was 32.26% (20/62). There were significant differences in BMI (25.31±4.63 vs. 27.96±4.72), osteoporosis ratio (47.62% vs. 85.00%), apex distance (24.43±1.65) mm vs. (26.84±2.18) mm], lateral wall classification (type Ⅰ-Ⅲ, fractions are 61.90%, 33.33%, 4.76% vs. 30.00%, 40.00%, 30.00%), thickness of outer wall (2.43±0.39) mm vs. (2.05±0.31) mm] between the two groups (all P < 0.05). The results of multivariate logistic regression analysis showed that the apex distance, lateral wall type and lateral wall thickness were independent influencing factors of hip joint function after PFNA-Ⅱ operation (all P < 0.05).  Conclusion  The large apex distance, poor integrity of the lateral wall and thin lateral wall are independent risk factors for hip dysfunction after PFNA-Ⅱ operation for unstable femoral intertrochanteric fractures.