高龄股骨转子间骨折髓内治疗失败行人工股骨头置换术后脱位的原因分析  

Cause Analysis of Dislocation After Femoral Head Replacement Surgery in Elderly Patients with Failed Intramedullary Treatment of Femoral Intertrochanteric Fracture

作　　者：张国瑞 孙振江 徐永申[3] 穆杰[3] Zhang Guorui;Sun Zhenjiang;Xu Yongshen(School of Clinical Medicine,Henan University of Science and Technology,Luoyang 450066,China;Department of Orthopaedics,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,China;Department of Orthopaedics,the Second Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,China)

机构地区：[1]河南科技大学临床医学院,洛阳450066 [2]河南科技大学第一附属医院骨外科,洛阳471003 [3]河南科技大学第二附属医院骨科,洛阳471000

出　　处：《华中科技大学学报(医学版)》2025年第2期247-254,共8页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：河南省医学科技攻关项目(No.LHGJ20220700)。

摘　　要：目的探究高龄股骨转子间骨折(femoral intertrochanteric fracture,FIF)髓内治疗失败行人工股骨头置换术(femoral head replacement,FHR)后脱位的原因。方法选择2018年12月至2023年1月于河南科技大学第一附属医院因股骨近端防旋髓内钉(PFNA)治疗后髓内钉失效行FHR治疗的FIF老年患者175例为研究对象,根据FHR术后股骨头是否脱位,分为脱位组(45例)和未脱位组(130例)。评估FHR的临床疗效,收集患者的临床资料(包括年龄、性别、围术期资料等)进行对比分析,判断影响FHR效果的因素是否存在多重共线性,采用LASSO回归分析筛选预测因子,根据多因素Logistic回归分析危险因素,通过各危险因素的比值比(OR)构建简易风险评分模型。绘制受试者工作特征(ROC)曲线评价模型的区分度,以Hosmer-Lemeshow(H-L)检验判断模型的校准度。结果与术前相比,术后1、12个月患者的各Harris评分均显著改善(均P<0.05);FHR术后患者并发症较少,主要包括肺部感染(2.86%)、下肢静脉血栓(2.86%)以及心功能障碍(2.86%)。LASSO回归模型获得6个预测因子,多因素Logistic回归分析发现其中患者年龄、神经及肌肉系统疾病、手术入路、术后生活习惯、术后护理为股骨头发生脱位的独立影响因素(均P<0.05)。简易风险评分模型的评分在0~21.6分,可划分为低危(<11分)、中危(11~15分)和高危(>15分)3个风险等级;训练集和验证集患者的脱位发生率无显著差异(P>0.05)。模型验证结果显示,其区分度和校准度较好。结论高龄患者FIF髓内钉固定失效后行FHR能够有效改善患者髋关节功能,且术后并发症较少。年龄、神经及肌肉系统疾病、手术入路、术后生活习惯、术后护理等为FHR后股骨头发生脱位的独立影响因素,在临床治疗时要加以重视及预防。Objective To explore the cause of dislocation after femoral head replacement(FHR)surgery in elderly patients with failed intramedullary treatment of femoral intertrochanteric fracture(FIF).Methods Elderly patients(175 cases)with FIF who underwent FHR treatment due to failure of intramedullary nails after proximal femoral nail anti-rotation(PFNA)treatment in our hospital from December 2018 to January 2023 were selected as the research subjects.According to whether the femoral head was dislocated after FHR surgery,the patients were divided into dislocation group(45 cases)and non-dislocation group(130 cases).The clinical efficacy of FHR surgery was evaluated,and clinical data of patients(including age,gender,perioperative data,etc.)was collected for comparative analysis.Multicollinearity of these factors was determined.LASSO regression analysis was used to screen for predictive factors.Based on multivariate logistic regression analysis of risk factors,simple risk scoring model was constructed using the odds ratio(OR)values of each risk factor.Receiver operating characteristic(ROC)curves were constructed to evaluate the discriminability of the model.Hosmer Lemeshow(H-L)test was used to judge the calibration of the model.Results Compared with preoperative,the Harris scores of patients at 1 and 12 months after surgery were significantly improved(P<0.05).Postoperative complications in FHR patients were relatively low,mainly including pulmonary infection(2.86%),lower limb thrombosis(2.86%),and cardiac dysfunction(2.86%).The LASSO regression model obtained 6 predictive factors,among which age,neurological and muscular system diseases,surgical approach,postoperative lifestyle habits,and postoperative care were all independent influencing factors for the occurrence of femoral head dislocation(P<0.05).The score of the simplified risk scoring model was 0~21.6 points,which can be divided into three risk levels:low risk(<11 points),medium risk(11—15 points),and high risk(>15 points).There was no significant difference in the

关 键 词：老年 股骨转子间骨折 股骨近端防旋髓内钉 人工股骨头置换术 

分 类 号：R687.3[医药卫生—骨科学]