三种植入物固定修复骨质疏松性股骨转子间骨折：失效单因素及多因素分析

Fixation with three kinds of implants to repair osteoporotic intertrochanteric fractures: univariate and multivariate analysis of failure

背景:股骨转子间骨折是老年骨质疏松患者常见的并发症之一,临床治疗以内固定为主,其中各项研究中选择的内固定物各有不同,但目前对内固定效果影响因素的相关研究较少。目的:探究骨质疏松性股骨转子间骨折老年患者内固定效果的相关影响因素。方法:选择东莞光华医院于2011年5月至2014年5月收治的86例骨质疏松性股骨转子间骨折老年患者作为研究对象,按照内固定方式分为3组,动力髋螺钉组34例,近端髓内钉组41例,股骨近端加压钢板组11例。对3组患者内固定失败率进行比较,对影响内固定效果的相关因素进行单因素及多因素分析。结果与结论:动力髋螺钉组有5例(15%)患者内固定失败,近端髓内钉组有11例(26%)患者内固定失败,股骨近端加压钢板组有4例(36%)患者内固定失败。单因素分析结果显示,患者的Evanse分型、外臂侧是否骨折、骨质疏松程度、骨折复位质量、尖顶距、有无合并内科疾病和内固定物选择与内固定效果有关(P<0.05),而患者内固定效果与性别、年龄、住院时间和下地活动时间无关(P>0.05)。多因素分析结果显示,不稳定性骨折、重度骨质疏松、外侧臂骨折、合并内科疾病、尖顶距>25 mm和不同内固定物都是影响患者内固定效果的独立因素。

BACKGROUND： Intertrochanteric fracture is one of the common complications in patients with senile osteoporosis. Internal fixation is a common method in clinical therapy. Different internal fixators are selected in different studies. However, there are few studies on influential factors for outcomes of internal fixation at present. OBJECTIVE： To investigate related influential factors for outcomes of internal fixation in elderly patients with osteoporotic intertrochanteric fracture. METHODS： A total of 86 elderly patients with osteoporotic intertrochanteric fracture, who were treated in the Guanghua Hospital from May 2011 to May 2014, were enrolled in this study. They were divided into three groups according to different manners of fixation. There were dynamic hip screw group （n=34）, proximal intramedullary nail group （n=41） and proximal femoral compression plate group （n=11 ）. Rate of fixation failure was compared among the three groups. The relevant factors affecting fixation effects were analyzed using univariate and multivariate analysis. RESULTS AND CONCLUSION： Internal fixation failure was detected in 5 patients （15%） in the dynamic hip screw group, 11 patients （26%） in the proximal intramedullary nail group, and 4 patients （36%） in the proximal femoral compression plate group. Results of univariate analysis revealed that Evanse genotyping of patients,whether fractures were found on outer arm side, degree of osteoporosis, quality of reduction, steeple distance, whether combined with internal medicine diseases and selection of fixator were associated with internal fixation effects （P 〈 0.05）. However, the internal fixation effects were not correlated with gender, age, hospital stay and ambulation time （P 〉 0.05）. Multivariate analysis results demonstrated that unstable fractures, severe osteoporosis, fractures of the lateral arm, medical illness, steeple distance 〉 25 mm, and different internal fixators are independent factors affecting internal fixation effects in patients.