股骨粗隆部骨折内固定失败原因分析

Analysis of the failure reason of internal fixation in peritrochanteric fractures

目的:总结分析股骨粗隆部骨折髓内和髓外固定失败发生的原因并提出预防措施。方法:对2005年5月至2009年6月北京大学第三医院连续收治的256例股骨粗隆部骨折患者采用回顾性分析,收集患者临床资料并采用电话或门诊随访,利用SPSS 13.0软件通过单因素及多因素Logistic回归,分析患者年龄、性别、骨折类型、骨骼质量、内固定种类、术后颈干角和Garden指数以及开始负重时间对内固定失败的影响,结合临床实践总结内固定失败的主要原因。结果:术后发生螺钉穿出、螺钉切出、螺钉断裂、骨折不愈合共10例,失败率5.15%。术后开始负重时间为内固定失败的危险因素(P<0.001),而年龄、性别、骨骼质量、骨折类型、内固定种类、术后颈干角和Garden指数与内固定失败无明显相关性(P>0.05)。结论:患者术后开始负重时间是内固定失败的危险因素,负重时间的选择应该根据患者的个体情况,如骨骼质量、骨折类型来确定。骨折类型>2.2型,Singh指数≤3,即使内固定位置良好,开始负重时间也应该选择在术后2个月。

Objective：To analyze the reasons and precautions for the failure of internal fixation in peritrochanteric fractures.Methods： A retrospective study of 256 patients treated in surgical way during the period of May 2005 to June 2009 in our hospital was utilized by Logistic regression via analyzing age,sex,type of fracture,bone quality,type of internal fixation device,neck-shaft angle,Garden index and the initial load time.Results： The ages of 256 patients ranged from 14 to 103 years.All the patients were treated by internal fixation,of whom 194 were followed up after surgery.The follow-up rate was 75.8% and follow-up time 12-53 months,with an average of 17.8 months.Ten cases failed after surgery because of penetration,cut and break-up of screw and bone non-union.The failure rate was 5.15%.The failure cases were 31-A2.2（4 cases,1.56%）,31-A2.3（5 cases,1.95%）,and 31-A3.1（1 cases,0.39%）.The type of failure devices： Dynamic hip screw（DHS） 3 cases,proximal femoral nail（PFN） 2 cases,proximal femoral nail anti-rotation（PFNA） 1 case,less invasive stabilization system（LISS） 4 cases.According to statistic results,initial load time after operation was a risk factor of internal fixation failure.Generally,the older,the more osteoporosis and the less effect of internal fixation.According to our experience,the more complex fracture,the more time before operation,the more difficult the reduction and the higher the rate of device failure.Conclusion： The initial load time after operation is crucial to the destiny of internal fixation.We should keep patients from early loading after operation and make a time table for the individual according to the patient＇s own condition.