老年股骨转子间骨折髓内钉内固定术后功能恢复危险因素分析

Analysis on risk factors of functional recovery after intramedullary nail fixation for femoral intertrochanteric fractures in elderly patients

目的:研究影响老年患者股骨转子间骨折髓内钉内固定术后髋关节功能恢复的相关因素,提出相应措施促进术后髋关节功能恢复。方法:选取2012年6月至2015年6月行股骨转子间骨折闭合复位髓内钉内固定术患者74例,男33例,女41例,平均年龄(75.07±7.89)岁。根据术后1年随访时Sanders功能评分将患者分为功能良好组(55例)和功能不良组(19例),统计患者年龄、性别、骨折分型、骨密度、术前基础疾病、营养状态、麻醉ASA分级、麻醉方式、术中复位情况、术后疼痛评分、术后并发症、尖顶距及是否康复师康复等相关因素。采用单因素和多因素Logistic分析对相关危险因素进行评估。结果 :单因素分析显示患者年龄、骨密度、营养状态、麻醉ASA分级、麻醉方式、复位情况、康复师康复,尖顶距对术后髋关节功能恢复差异有统计学意义(P<0.05);多因素Logistic回归分析显示骨密度(P=0.006,OR=0.077),康复师康复(P=0.006,OR=0.070),麻醉ASA分级(P<0.001,OR=0.049),营养状态(P=0.046,OR=0.188)是术后髋关节功能恢复的独立影响因素。结论 :骨密度、康复师康复、麻醉ASA分级和营养状态影响老年股骨转子间骨折髓内钉内固定术后功能恢复,通过整合骨科、麻醉科、康复科、营养科等学科,建立快速康复外科体系,可有效促进老年患者术后髋关节功能恢复。

Objectives：To investigate the risk factors of functional recovery after intramedullary nail fixation for femoral intertrochanteric fracture in elderly patients,and to propose corresponding measures to promote postoperative hip function recovery. Methods：From June 2012 to June 2015,74 patients after intramedullary nail fixation surgery were analyzed,including33 males and 41 females,with an average age of（75.07±7.89） years old,and divided into well function group（55 patients） and bad-function group（19 patients） according to Sanders function criterion. Age,gender,bone density,fracture type,systemic disease,complication,rehabilitation exercises with therapist or not,nourishment state,anesthesia method,fracture reduction condition,ASA classification,tip apex distance were reviewed and analyzed by t test,non-parametric test, χ2 test and Logistic analysis. Results：Univariate analysis showed that age,bone density,nourishment state,ASA classification,anesthesia method,fracture reduction condition,rehabilitation exercises with therapist,and tip apex distance were the risk factors for the recovery of hip function. Logistic analysis showed that bone density（P=0.006,OR=0.077）,rehabilitation exercises with therapist（P=0.006,OR=0.070）,ASA classification（P〈0.001,OR=0.049）,nourishment state（P=0.046,OR=0.188） were the risk factors for the functional recovery. Conclusion：Bone density,rehabilitation exercises with therapist,ASA classification,nourishment state were the risk factors for the functional recovery of intramedullary nail fixation for intertrochanteric fracture in elderly patients.Multidisciplinary cooperation and fast track surgery system should be set up to promoting the hip functional recovery.