致股骨近端锁定钢板治疗股骨近端骨折失败的原因探究

Analyzing the causes of failure for proximal femoral locking plate in the treatment of proximal femoral fractures

目的：分析股骨近端锁定钢板失败的相关危险因素。方法选取2010年1月-2014年12月医院行股骨近端锁定钢板治疗股骨近端骨折患者41例，男14例，女27例，年龄56～82岁，中位年龄67岁，共9例患者出现股骨近端锁定钢板失败，患者的年龄、性别、糖尿病、体质量指数、吸烟、骨质疏松以及小转子复位情况纳入可能的危险因素作为研究对象，统计学方法采用多变量的Logistic回归分析。结果股骨近端小转子的复位与股骨近端锁定钢板的失败显著相关（ P=0.033），而年龄、性别、糖尿病、体质量指数、吸烟、骨质疏松与股骨近端锁定钢板的失败无显著相关性（相应P=0.158，P=0.348，P=0.229，P=0.728，P=0.954，P=0.456）。结论股骨近端锁定钢板治疗股骨近端骨折，尤其是不稳定骨折有较高的失败率，还有待于进一步的生物力学和临床研究予以验证。

Objective To analyze the related risk factors of proximal femoral locking plate failure. Methods 41 pa-tients（14 males,27 females;mean age 67 years,range 56 ～82years）presenting with proximal femoral fractures treated with open reduction locked plate osteosynthesis at our institution′s trauma centre were collected from reference room from January 2010 to December 2014,nine patients with proximal femoral locking plate failure,Age,gender,diabetes,body mass index, smoking,osteoporosis and medial buttress reconstruction were acted as possible risk factors in the study,statistical methods e. g. multivariate logistic regression model was performed. Results In the study,there is a significant statistical difference be-tween medial buttress reconstruction and proximal femoral locking plate failure（P=0. 033）. Nevertheless,there was no statis-tically significant difference between groups with regards to age,gender,diabetes,body mass index,smoking or osteoporosis （P=0. 158,P=0. 348,P=0. 229,P=0. 728,P=0. 954,P=0. 456,respectively）. Conclusion Proximal femoral fractures treated with proximal femoral locking plate have a high failure rate,especially for the unstable fractures,but further biomechani-cal and clinical studies are required to evaluate the conclusion of this study.