髓内钉固定治疗老年股骨转子间骨折髋螺钉切出的危险因素分析  

Risk factors for cutout failure in geriatric intertrochanteric fracture patients after cephalomedullary nail fixation

作　　者：郝有亮[1] 周方[1] 姬洪全[1] 田耘[1] 张志山[1] 郭琰[1] 吕扬[1] 杨钟玮 侯国进[1] HAO You-liang;ZHOU Fang;JI Hong-quan;TIAN Yun;ZHANG Zhi-shan;GUO Yan;LYU Yang;YANG Zhong-wei;HOU Guo-jin(Department of Orthopaedics,Peking University Third Hospital,Engineering Research Center of Bone and Joint Precision Medicine,Beijing 100191,China)

机构地区：[1]北京大学第三医院骨科骨与关节精准医学工程研究中心,北京100191

出　　处：《中国骨伤》2025年第2期141-147,共7页China Journal of Orthopaedics and Traumatology

基　　金：国家重点研发计划(编号:2018YFF0301102);北京大学第三医院临床重点项目(编号:BYSYZD2023040)。

摘　　要：目的:探讨老年股骨转子间骨折患者接受髓内钉固定术后发生髋螺钉切出的危险因素。方法:回顾性分析2008年1月到2018年8月接受髓内钉治疗的518例股骨转子间骨折老年患者资料,其中,男167例,女351例;年龄65~97岁。根据是否发生髋螺钉切出,将其分为愈合组508例和切出组10例。对两组患者的一般资料、手术资料、影像学资料进行比较,再按照性别、年龄、身体质量指数(body mass index,BMI)、美国麻醉师协会(American Society of Anesthesiologists,ASA)对切出组进行倾向性评分匹配,按照1∶4的比例,匹配出愈合组40例。对影响髋螺钉切出的潜在危险因素进行分析,采用多因素Logistic回归模型对影响髋螺钉切出的独立危险因素进行分析。结果:愈合组和切出组患者在年龄、性别、BMI、ASA分级、AO分型方面的差异均无统计学意义,两组在复位质量方面的差异具有统计学意义(P=0.003),两组在尖顶距方面的差异具有统计学意义(P<0.001)。多因素Logistic回归分析显示复位质量差[OR=23.138,95%CI(2.163,247.551),P=0.009]和尖顶距≥25 mm[OR=30.538,95%CI(2.935,317.770),P=0.004]是导致髋螺钉切出的独立危险因素。结论:复位质量差和尖顶距≥25 mm是老年股骨转子间骨折患者接受髓内钉固定术治疗时发生髋螺钉切出的独立危险因素。尖顶距的最佳数值仍有待进一步研究。Objective To determine risk factors for cutout failure in geriatric intertrochanteric fracture patients after cephalomedullary nail fixation.Methods A retrospective review of 518 elderly patients who underwent cephalomedullary nail fixation for intertrochanteric fractures between January 2008 and August 2018 was conducted,including 167 males and 351 females,age from 65 to 97 years old.All patients were followed up for at least one year after surgery and divided into a healed group and a cutout group based on whether the hip screw cutout occurred.Among all patients,10 cases experienced hip screw cutout.The general information,surgical data,and radiological data of the two groups were compared,and risk factors influencing hip screw cutout were analyzed.Propensity score matching was then performed on the cutout group based on gender,age,body mass index(BMI),and American Society of Anesthesiologists(ASA),and 40 patients from the healed group were matched at a ratio of 1∶4.Key risk factors affecting hip screw cutout were further analyzed.Multivariable logistic regression analysis was conducted to evaluate associations between variables and cutout failure.Results There were no statistically significant differences between the healed group and the cutout group in terms of age,gender,BMI,ASA,and AO classification.However,statistically significant differences were observed between the two groups in terms of reduction quality(P=0.003)and tip-apex distance(TAD),P<0.001.Multivariate analysis identified poor reduction quality OR=23.138,95%CI(2.163,247.551),P=0.009 and TAD≥25 mm OR=30.538,95%CI(2.935,317.770),P=0.004 as independent risk factors for cutout failure.Conclusion The present study identified poor reduction quality and TAD≥25 mm as factors for cutout failure in geriatric intertrochanteric fractures treated with cephalomedullary nails.Further studies are needed to calculate the optimal TAD for cephalomedullary nails.

关 键 词：髋骨折 老年人 骨折固定术 髓内 内固定失败 

分 类 号：R683.4[医药卫生—骨科学]