股骨转子间骨折股骨近端防旋髓内钉置入后髋关节功能恢复及预测模型构建  

Hip joint function recovery and prediction model construction after proximal femoral nail antirotation for intertrochanteric fractures

作　　者：严金涟 许争权 魏仁杰 王业华 Yan Jinlian;Xu Zhengquan;Wei Renjie;Wang Yehua(Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China;Department of Orthopedics,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China)

机构地区：[1]徐州医科大学,江苏省徐州市221000 [2]徐州医科大学附属医院骨科,江苏省徐州市221000

出　　处：《中国组织工程研究》2025年第33期7189-7195,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:目前国内外研究主要集中在不同术式治疗股骨转子间骨折的比较及股骨近端防旋髓内钉手术失败的风险,对股骨近端防旋髓内钉术后患肢髋关节功能预后研究较少。目的:分析老年转子间骨折患者行股骨近端防旋髓内钉置入后髋关节功能恢复不良的影响因素,构建术后髋关节功能预测评分系统并探讨其价值。方法:选择2021年6月至2023年6月在徐州医科大学附属医院接受股骨近端防旋髓内钉内固定治疗的股骨转子间骨折患者150例,根据术后随访Harris髋关节功能评分分组,评分≥80分为优良组,评分<80分为不良组,采用单因素及二元回归分析探讨导致术后髋关节功能不良的危险因素,根据危险因素建立评分表。采用受试者工作曲线探讨该评分系统预测股骨近端防旋髓内钉置入术后髋关节功能的价值。结果与结论:①150例患者根据术后1年随访时患侧髋关节Harris评分标准分组,功能恢复不良组52例,恢复优良组98例,不良率为34.7%;②两组患者单因素比较结果显示:术后髋关节功能不良组与优良组在年龄、骨密度、术前基础合并症数量、外侧壁的分型、螺旋刀片位置、复位质量及术后初次下床锻炼时间方面存在显著差异(P<0.05);③二元Logistic回归分析结果显示:年龄≥75岁(OR=2.834)、骨质疏松(OR=3.002)、术前基础合并症数量>2个(OR=4.024)、外侧壁破裂(OR=2.999)、螺旋刀片位置差(OR=4.025)、术后初次下床锻炼时间>4周(OR=3.153)是转子间骨折行股骨近端防旋髓内钉置入术后髋关节功能不良的独立危险因素(P<0.05),复位质量差(OR=1.026)是非独立危险因素(P>0.05);④依据二元回归分析结果构建术后髋关节功能优良预测评分系统,经受试者工作特征曲线分析,此评分系统预测术后髋关节功能不良的界值为4.5分,曲线下面积为0.797,灵敏度为83.7%,特异性为65.4%;⑤提示年龄≥75岁、骨质疏松、术前BACKGROUND:At present,domestic and foreign studies mainly focus on the comparison of different operation methods for intertrochanteric fracture of femur and the risk of failure in proximal femoral nail antirotation operation.There are few studies on the prognosis of hip function of affected limb after proximal femoral nail antirotation.OBJECTIVE:To analyze the influencing factors of poor hip function recovery in elderly patients with intertrochanteric fracture after proximal femoral nail antirotation surgery,and to construct a score system for predicting hip function after surgery and explore its value.METHODS:A total of 150 patients with intertrochanteric fracture of femur who received proximal femoral nail antirotation surgery in the Affiliated Hospital of Xuzhou Medical University from June 2021 to June 2023 were selected and divided into groups according to the Harris hip function score during postoperative follow-up.A score≥80 was considered as the good group,and a score<80 was considered as the poor group.Univariate and binary regression analyses were used to explore the risk factors leading to postoperative hip dysfunction.A score scale was established according to the risk factors.The value of this scoring system in predicting hip function after proximal femoral nail antirotation was investigated by using receiver operating characteristic curve.RESULTS AND CONCLUSION:(1)Among the 150 patients,according to the Harris score standard of the affected hip joint at 1 year follow-up,there were 52 cases in the group with poor functional recovery and 98 cases in the group with excellent functional recovery,with an unsatisfactory rate of 34.7%.(2)The results of univariate comparison between the two groups showed that there were significant differences in age,bone mineral density,number of preoperative underlying complications,type of lateral wall,position of spiral blade,quality of reduction and time of first exercise after surgery between the poor group and the good group(P<0.05).(3)The results of binary Logisti

关 键 词：股骨转子间骨折 股骨近端抗旋髓内钉 随访 髋关节功能 骨质疏松 危险因素 骨科植入物 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R683