股骨外侧壁形态对股骨转子区骨折内固定失效的预测研究  

Prediction of internal fixation failure of femoral trochanteric fracture by external wall morphology

作　　者：张欣[1] 马能峰 胡旭峰[1] 杨民[1] 程文静 ZHENG Xin;MA Neng-feng;HU Xu-feng;YANG Min;CHENG Wen-jing(Department of Traumatic Orthopaedics,the First Affiliated Hospital of Wannan Medical College,Wuhu,241000,Anhui,China)

机构地区：[1]皖南医学院弋矶山医院创伤骨科,安徽芜湖241000

出　　处：《中国骨伤》2023年第3期242-246,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨外侧壁形态与股骨转子区骨折早期内固定失效的关系。方法:选取2015年1月至2020年1月行内固定治疗的295例股骨转子区骨折患者,根据术后是否出现早期内固定失败将患者分为两组,即失败组19例和正常组276例。对两组患者性别、患侧、年龄、AO分型、身体质量指数(body mass index,BMI)、术前血红蛋白、X线测量下外侧壁厚度、术前合并内科疾病、术中失血量、术后尖顶距(tip apex distance,TAD)、术后颈干角、手术时间等资料进行比较。比较两组外侧壁形态,对外侧壁形态与股骨转子区骨折早期内固失效进行相关性分析。结果:两组患者术后随访1年以上。两组患者在术中失血量、手术时间、术后TAD、术后颈干角等方面比较,差异无统计学意义(P>0.05)。末次随访失败组视觉模拟评分(visual anague scale,VAS)高于正常组(P<0.01),失败组Harris评分小于正常组(P<0.05)。绘制外侧壁形态与股骨转子区骨折早期内固定失败之间的受试者工作特征(receiver operator characteristic,ROC)曲线,中点侧壁厚度的临界值为16.5 mm,ROC曲线下面积0.845;平均侧壁厚度的临界值为16.5 mm,ROC曲线下面积0.838;侧壁轴向面积的临界值为7.5 mm,ROC曲线下面积0.826。结论:CT测量下股骨外侧壁形态可作为股骨转子区骨折早期内固定失效的预测因素,对于有风险的患者,应制定更加合理的手术方案及术后预防措施。Objective To investigate the relationship between the shape of the lateral wall and the early failure of internal fixation in the fracture of the femoral trochanteric region(FFT).Methods Total 295 patients with femoral trochanteric fracture underwent internal fixation from January 2015 to January 2020 were selected.The patients were divided into two groups according to whether there was early internal fixation failure after surgery,19 patients in the failure group and 276 patients in the normal group.Gender,affected side,age,AO classification,body mass index(BMI),preoperative hemoglobin,X-ray measurement of lower lateral wall thickness,preoperative internal diseases,intraoperative blood loss,postoperative tip apex distance(TAD),postoperative neck shaft angle,operation time and other data were compared between two groups.The shape of the lateral wall was compared between two groups,and the correlation between the shape of the lateral wall and the early internal fixation failure of femoral trochanteric fracture was analyzed.Results All patients were followed up for more than 1 year.There was no significant difference between two groups in terms of intraoperative blood loss,operation time,postoperative TAD,and postoperative neck shaft angle(P>0.05).At the latest follow-up,the visual anaglue scale(VAS)of the failure group was higher than that of the normal group(P<0.01),and the Harris score of the failure group was lower than that of normal group(P<0.05).The receiver operator characteristic(ROC)curve between shape of lateral wall and failure of early internal fixation of femoral trochanteric fracture was drawn.The critical value of the midpoint lateral wall thickness was 16.5 mm,and the area under the ROC curve was 0.845;The critical value of average sidewall thickness was 16.5 mm,and the area under ROC curve was 0.838;The critical value of the axial area of the sidewall was 7.5 mm,and the area under the ROC curve was 0.826.Conclusion The shape of the lateral femoral wall measured by CT could be used as a predictive

关 键 词：股骨外侧壁 股骨转子区骨折 内固定失效 

分 类 号：R683.42[医药卫生—骨科学]