老年股骨转子间骨折髓内钉固定中不同复位质量对临床预后的影响——基于影像学特征分析  

Impact of reduction quality during intramedullary nailing of intertrochanteric femur fractures on outcomes of elderly patients:imaging characteristics analysis

作　　者：陈文龙 曾祥鸿 罗景胜 Chen Wenlong;Zeng Xianghong;Luo Jingsheng(Department of Orthopedics,The First Affiliated Hospital of Gannan Medical University,Ganzhou,Jiangxi Province 341000,China)

机构地区：[1]赣南医科大学第一附属医院骨科,江西赣州341000

出　　处：《创伤外科杂志》2025年第4期265-271,共7页Journal of Traumatic Surgery

基　　金：赣州市指导性科技计划项目(GZ2020ZSF009)。

摘　　要：目的 观察老年股骨转子间骨折患者采用髓内钉固定,术毕不同骨折复位质量的影像学表现对临床预后的影响。方法 回顾性分析2018年1月—2022年12月赣南医科大学第一附属医院骨科行防旋股骨近端髓内钉(PFNA)治疗的71例老年股骨转子间骨折患者临床资料。其中男性30例,女性41例;年龄70~92岁,平均76.8岁;跌倒伤30例,道路交通伤31例,其他10例。患者术前均利用X线片、CT重建明确诊断。依据术后第1天3D-CT图像,按头颈骨块前内侧皮质与股骨干前内侧皮质是否支撑砥住的关系,分为阳性支撑组12例、中性支撑组22例、阴性支撑组37例。记录患者性别、年龄、ASA分级、合并疾病、受伤至手术时间、手术时间、出血量,对比术后3d、3个月X线正位片的颈干角、股骨颈长度、退钉距离、负重时间及术后12个月髋关节功能Harris评分。结果 患者随访12~15个月,平均13.0个月。患者均获得骨性愈合,三组患者在年龄、性别、ASA分级、合并疾病、手术时间、出血量方面比较差异无统计学意义。术后1d三组颈干角[阳性支撑组:(134.5±3.8)°,中性支撑组:(130.9±3.6)°,阴性支撑组:(132.2±2.3)°]、股骨颈长度[阳性支撑组:(46.5±2.4)mm,中性支撑组:(45.1±3.4)mm,阴性支撑组:(43.5±1.9)mm]比较差异无统计学意义(P均>0.05)。术后3个月,阳性支撑组和中性支撑组颈干角[阳性支撑组:(133.5±2.4)°,中性支撑组:(129.9±3.1)°,阴性支撑组:(120.1±1.1)°]、股骨颈长度[阳性支撑组:(45.5±2.8)mm,中性支撑组:(43.8±1.9)mm,阴性支撑组:(37.6±2.9)mm]丢失多于阴性支撑组,阴性支撑组的退钉距离为(8.2±0.6)mm,明显大于阳性支撑组(1.5±0.2)mm、中性支撑组(1.6±0.3)mm,差异有统计学意义(P均<0.05)。阴性支撑组术后完全负重下地时间为(62.5±3.5)d,较阳性支撑组(42.5±3.1)d、中性支撑组(46.5±3.4)d明显延长,差异有统计学意义(P均<0.05)。阳性支撑组、中性支�Objective To investigate the predictive value of postoperative 1-d imaging findings for different reduction quality on clinical outcomes in elderly patients with intertrochanteric fractures treated with proximal femoral nail anti-rotation(PFNA).Methods This retrospective analysis was performed on elderly patients with intertrochteric fractures who received PFNA fixation in our hospital from Jan.2018 to Dec.2022.A total of 71 patients with neutral alignment of the medial cortex on anteroposterior X-ray films on the first day after surgery were screened and included in this study,with 30 males and 41 females aged 70-92(mean 76.8)years.Among them,there were 30 cases of falls,31 road traffic injuries,and 10 others.According to the postoperative 1-d 3D-CT images,the anatomic support between the anteromedial cortex of the head and neck bone fragments and the anteromedial cortex of the femoral shaft were evaluated and patients were classified into positive,neutral,and negative support groups.There were 12 cases in the positive support group,22 in the neutral support group,and 37 in the negative support group.Gender,age,ASA grade,comorbidities,preoperative time,operation time,and intraoperative blood loss were recorded.The neck-shaft angle,femoral neck length,nail-removal distance,weight-bearing time at postoperative 1 d and 3 months on X-ray films,as well as hip Harris score at 12 months after surgery were analyzed.Results Patients were followed up for 12-15(mean 13.0)months.All patients achieved bone healing.No statistically significant differences were found in terms of age,sex,ASA grade,comorbidities,operation time,and intraoperative blood loss among the three groups.The neck-shaft angle and femoral neck length showed no obvious difference at postoperative 1 d,but they were significantly larger in the positive,and neutral support groups than in the negative support group at postoperative 3 months(neck-shaft angle:133.5°±2.4°and 129.9°±3.1°vs.120.1°±1.1°;femoral neck length:mm,45.5±2.8 and 43.8±1.9 vs.37.6�

关 键 词：股骨转子间骨折 内固定 影像学 中性对位 复位质量 

分 类 号：R683.42[医药卫生—骨科学]