PFNA内固定治疗股骨粗隆间骨折疗效的多因素分析

Multivariate analysis of efficacy of PFNA fixation for femoral intertrochanteric fracture

目的以股骨粗隆间骨折股骨近端防旋髓内钉(PFNA)内固定术后疗效为因变量进行多因素分析,确定影响手术效果的因素并为临床提供指导意见。方法回顾性分析自2012-01—2014-11诊治的股骨粗隆间骨折250例,根据患者治疗后30 d的髋关节功能Harris评分结果分组。将Harris评分≥75分者纳入疗效优良组(190例),将Harris评分<75分者纳入疗效不良组(60例)。单因素分析2组性别、年龄、致伤原因、AO分型、ASA分级、骨折稳定性、合并症、手术时间、手术时机,采用多因素Logistic分析影响疗效的危险因素。结果经单因素分析,年龄、AO分型、ASA分级、骨折稳定性和手术时机为PFNA内固定术治疗股骨粗隆间骨折疗效的相关影响因素(P<0.05),而性别、致伤原因、并发症及手术时间比较差异无统计学意义(P>0.05)。经Logistic多因素回归分析,年龄和ASA分级是影响PFNA内固定术治疗股骨粗隆间骨折疗效的独立危险因素(P<0.05)。结论高龄和手术时机偏晚是影响股骨粗隆间骨折PFNA内固定术后疗效的危险因素,AO分型、ASA分级和骨折稳定性等对疗效可能也存在一定影响。

Objective To perform multivariate analysis of effect as the dependent variable of PFNA fixation for femoral intertrochanteric fracture, determine the factors affecting the surgical results and provide guidance for clinical practice. Methods Two hundred and fifty cases of clinical data receiving surgery from January 2012 to November 2014 were retrospectively analyzed, were grouped according to the Harris hip score result 30 d after treatment, the score≥75 points were included in the excellent efficacy group, 190 cases; the score 〈75 points were included in the non-performing efficacy group, 60 cases. Gender, age, cause of injury, AO classification, ASA classification, fracture stability, complications, operative time, timing of surgery, etc. of two groups were compared, and risk factors of effect were analyzed. Results By univariate analysis, age, AO classification, ASA classification, fracture stability and mobile opportunity were relevant factors of PFNA fixation for femoral intertrochantoric fracture （P 〈0.05）, and there were no significant differences in gender, cause of injury, complications and operative time （P 〉0.05）. By Logistic regression analysis, age and ASA classification was independent risk factor of PFNA fixation for femoral intertrochanteric fracture（P 〈0.05）, and the differences were not statistically significant in AO classification, fracture stability and timing of surgery （P 〉0.05）. Conclusion The elderly and late surgery are risk factors of efficacy of PFNA internal fixation for treatment of femoral intertrochanteric fractures, while AO classification, ASA classification and fracture stability, may also have some influence on the fractures.