股骨近端防旋髓内钉治疗老年人髋部骨折疗效的多因素分析

Multivariate analysis of geriatric intertrochanteric fractures treated with proximal femoral nail antirotation(PFNA)

目的研究股骨近端防旋髓内钉(PFNA)治疗老年股骨粗隆间骨折的疗效,并分析影响预后的因素。方法 76例股骨粗隆间骨折患者接受PFNA内固定治疗,记录患者一般情况、骨折类型、手术时间、术中出血量、围手术期并发症,患侧髋关节Harris评分。结果术后并发症发生率:表浅软组织感染2.6%(2例),心脑血管意外3.9%(3例),肺炎6.6%(5例),老年谵妄15.8%(12例),术后DVT 5.3%(4例),应激性溃疡2.6%(2例)。多因素回归分析显示年龄、骨折稳定性(股骨内后侧皮质)、ASA评分是骨折愈合后髋关节功能的预测因子(P=0.032,P=0.032,P=0.038),性别、入院后早期手术、手术时间与Harris评分差异无统计学意义(P>0.05)。结论 PFNA内固定治疗老年股骨粗隆间骨折创伤较小,但围手术期仍有较多并发症。骨折稳定性、患者年龄、ASA评分与骨折愈合后髋关节功能相关。

Objective To investigate the clinical and functional outcome of the proximal femoral nail antirotation（PFNA） in the treatment of geriatric intertrochanteric fractures and analylze various factors affecting the prognosis.Methods All of 76 patients with intertrochanteric fractures treated with PFNA were included.Patients’ general health,injury mechanism,fracture pattern,operation time,intraoperative blood loss,perioperative complications,bone healing and evaluation of the operated hip joint were reviewed.Results The incidence of superficial infection occurred 2.6%（n=2）,cerebrocardiovascular accidents 3.9%（n=3）,postoperative pneumonia was 6.6%（n=5）,geriatric delirium 15.8%（n=12）,postoperative deep venous thrombosis 5.3%（n=4）,upper peptic tract hemorrhage 2.6%（n=2）.Multivariate analysis indicated that age,fracture stability,ASA score was the predictors of postoperative hip function（P =0.032,P =0.032,P =0.038） while gender,early operation and operation time was not statistically correlated with hip joint function（P 〉0.05）.Conclusion PFNA is a suitable and less invasive procedure for geriatric intertrochanteric fractures via stable fixation and early rehabilitation but the complication incidence is relatively high.Age,fracture stability and ASA score may be related to the postoperative hip joint function.