动力髋螺钉植入老年稳定型转子间骨折术后再移位的相关因素分析

Redisplacement of stable elderly intertrochanteric fractures after dynamic hip screw fixation: A related factor analysis

目的:评估稳定型转子间骨折行动力髋螺钉内固定术后移位的危险因素。方法:四川大学华西第一附属医院骨科2003-02/2005-02采用动力髋螺钉内固定治疗稳定型转子间骨折患者39例。术后随访6～25个月,观察骨折愈合时间和骨折再移位情况。为进一步分析可能会导致骨折再移位的因素,将骨折再次移位患者和未移位患者的年龄,性别,拉力螺钉的位置、闭合复位的情况、是否发生医源性股骨外侧骨皮质骨折等情况进行比较。结果:39例稳定型转子间骨折中有35例患者进入结果分析。①35例患者骨折愈合的平均时间为术后4.1个月(2.6～6.5个月)。其中6例患者出现了内固定物或骨折块的移位。所有患者均未出现螺钉断裂,骨折均愈合,除1例患者因为疼痛和螺钉滑脱再次手术外,其余患者均未再手术。②再移位患者平均年龄大于未移位患者(81岁,72岁,P=0.006)。再移位患者发生医源性股骨外侧皮质骨折明显多于未移位患者(4例,1例,P=0.0001)。运用了逻辑回归方程检验变量之间关联后发现医源性股骨外侧皮质骨折与患者年龄有较强的关联性(r=0.76)。结论:年龄和医源性股骨外侧皮质骨折是影响股骨转子间骨折术后移位的主要因素,且两者之间存在较强的关联性。

AIM： To evaluate the risk factors for the stable intertrochanteric fractures after dynamic hip screw （DHS） fixation. METHODS： Thirty-nine cases of intertrochanteric fractures treated by DHS fixation in West China First Hospital of Sichuan University were selected between February 2003 and February 2005. They were followed for 6-25 months to observe the fracture healing time and displacement. To further explore the risk factors for the displacement, the age, gender, screw location, closed reduction, whether having iatrogenic lateral cortical bone fracture of femur of patients with re-displacement or without were compared. RESULTS： Thirty-five of 39 cases were involved in the result analysis. （1）Mean time for recovery was 4.1 months （2.6- 6.5 months）, and 6 cases were found the displacement of the fragments or fixture. All fractures united with no screw breakage, and no patients received a re-operation except 1 due to the pain and screw slippage. （2）The mean age of the patients with displacement was higher than those without displacement （81 years old, 72 years old, P =0.006）. Latrogenic comminition of the lateral cortex occurred more in the patients with displacement compared with those without displacement （4 cases, 1 case, P =0.000 1 ）. The logical regression equation showed that the comminution of the lateral cortex was highly correlated with the age of patients （r-- 0.76）. CONCLUSION： Age and iatrogenic fragmentation of the lateral cortex are the important factors for the displacement of stable intertrochanteric fractures, and there is close correlation between them.