老年股骨粗隆间骨折手术患者内固定失败的影响因素  

Influencing factors of internal fixation failure in elderly patients with intertrochanteric fractures of femur

作　　者：万涛 甘坤平 江开能 WAN Tao;GAN Kunping;JIANG Kaineng(Orthopaedics Department of Yingtan Rongji Orthopaedic Hospital,Yingtan 335000 Jiangxi,China)

机构地区：[1]鹰潭荣济骨科医院骨科,江西鹰潭335000

出　　处：《中国民康医学》2025年第2期18-21,25,共5页Medical Journal of Chinese People’s Health

摘　　要：目的:分析老年股骨粗隆间骨折手术患者内固定失败的影响因素。方法:回顾性分析2020年5月至2023年10月该院收治的186例接受股骨近端防旋髓内钉(PFNA)内固定术治疗的老年股骨粗隆间骨折患者的临床资料,统计老年股骨粗隆间骨折手术患者内固定情况,根据内固定是否失败将其分为失败组和成功组,分析其内固定失败的影响因素。结果:两组体质量指数、颈干角、吸烟史、饮酒史、骨折位置、合并基础内科疾病、骨折类型、骨折至内固定术时间、术前股骨颈骨密度、后内侧完整性比较,差异均无统计学意义(P>0.05);两组年龄、性别、骨折受伤机制、髓内钉主钉位置、股骨皮质厚度指数、顶尖距、螺旋刀片位置、骨折复位质量、外侧壁完整性比较,差异均有统计学意义(P<0.05);Logistic回归分析结果显示,年龄≥70岁、女性、高能量损伤、髓内钉主钉位置在股骨髓腔内侧或外侧、骨折复位质量差、螺旋刀片位置不理想、股骨皮质厚度指数<0.3、外侧壁不完整均为老年股骨粗隆间骨折手术患者内固定失败的危险因素(OR>1,P<0.05)。结论:年龄≥70岁、女性、高能量损伤、髓内钉主钉位置在股骨髓腔内侧或外侧、骨折复位质量差、螺旋刀片位置不理想、股骨皮质厚度指数<0.3、外侧壁不完整均为老年股骨粗隆间骨折手术患者内固定失败的危险因素。Objective:To analyze influencing factors of internal fixation failure in elderly patients with intertrochanteric fractures of femur.Methods:The clinical data of 186 elderly patients with intertrochanteric fractures treated with proximal femoral nail anti-rotation(PFNA)internal fixation in this hospital from May 2020 to October 2023 were retrospectively analyzed.The failure of internal fixation in these elderly patients with intertrochanteric fractures was analyzed.According to whether the internal fixation failed,they were divided into failure group and success group.The influencing factors of internal fixation failure were analyzed.Results:There were no significant differences in body mass index,neck shaft angle,smoking history,drinking history,fracture location,combined basic medical diseases,fracture type,time from fracture to internal fixation,preoperative femoral neck bone mineral density and posteromedial integrity between the two groups(P>0.05).There were significant differences in age,gender,fracture injury mechanism,intramedullary nail position,femoral cortical thickness index,apical distance,anti-rotation blade position,fracture reduction quality and lateral wall integrity between the two groups(P<0.05).Logistic regression analysis showed that age≥70 years,female,high-energy injury,intramedullary nail main nail position in the medial or lateral femoral medullary cavity,poor reduction quality,unsatisfactory anti-rotation blade position,femoral cortical thickness index<0.3,and incomplete lateral wall were all risk factors for internal fixation failure in the elderly patients with intertrochanteric fracture surgeries(OR>1,P<0.05).Conclusions:Age≥70 years old,female,high-energy injury,intramedullary nail main nail position in the medial or lateral femoral medullary cavity,poor reduction quality,unsatisfactory anti-rotation blade position,femoral cortical thickness index<0.3,and incomplete lateral wall are the risk factors for internal fixation failure in the elderly patients with intertrochanteric fract

关 键 词：股骨近端防旋髓内钉内固定术 老年 股骨粗隆间骨折 内固定失败 影响因素 

分 类 号：R687.3[医药卫生—骨科学]