老年股骨粗隆间骨折PFNA内固定术后骨折不愈合的危险因素分析

Analysis of Risk Factors of Non-union of Senile Femoral Intertrochanteric Fractures after the PFNA Internal Fixation Surgery

目的集中探讨老年股骨粗隆间骨折采用PFNA内固定术后骨折不愈合的相关危险因素。方法纳入2016年10月—2017年6月因股骨粗隆间骨折于该院骨科进行治疗的患者74例,在对患者进行为期1个月的治疗后,针对其髋关节功能Harris评分结果对患者进行分组,其中观察组患者为Harris评分≥75分,共54例;另20例患者为对照组患者,Harris评分<75分,对影响老年股骨粗隆间骨折PFNA内固定术后骨折不愈合的危险因素分析。结果针对PFNA治疗股骨粗隆间骨折的相关因素进行分析,结果显示,患者性别、致伤原因、合并症及手术时间对于患者的愈后影响不大,差异无统计学意义(P>0.05),而患者年龄(≥70岁14例vs 9例)、AO分型(A1型14例vs 4例)、ASA分型(2级16例vs 1例)、骨折稳定性(稳定21例vs 2例)和手术时机(≥3 d 26例vs 6例)的选择对于患者的愈后影响较大,差异有统计学意义(P<0.01);针对影响股骨粗隆间骨折PFNA内固定术疗效的多因素分析结果显示,患者的年龄、ASA分级为患者愈后的独立影响因素,差异有统计学意义(P<0.05),而临床AO分型、骨折稳定性和手术时机为患者愈后的非独立影响因素,差异无统计学意义(P>0.05)。结论患者的年龄和手术的时机是影响患者股骨粗隆间骨折PFNA内固定术后疗效的危险因素,而AO分型、ASA分级和骨折的稳定性也会对患者的愈后造成不同程度的影响。

Objective To focus on the relevant risk factors of non-union of senile femoral intertrochanteric fractures?after the PFNA internal fixation surgery.Methods 74 cases of intertrochanter fracture of femur patients in our hospital from October 2016 to June 2017 were selected,after 1-month treatment,the patients were divided into groups according to the hip joint function Harris marking results,including the observation group whose Harris score≥75 points,(54 cases)and the control group whose Harris<75 points,(20 cases),and the influence factors of non-union of senile Femoral intertrochanteric fractures after the PFNA internal fixation surgery were analyzed.Results The relevant factors of f non-union of senile Femoral intertrochanteric fractures after the PFNA internal fixation surgery showed that the gender,sex,injury causes,complications and operation time had a small effect on the prognosis of patients,and the differences were not statistically significant(P>0.05),and the age(≥70 years old 14 cases vs 9 cases),AO typing(A1 type 14 cases vs 4 cases),ASA classification(level 2,16 cases vs 1 cases)and fracture stability(stable 21 cases,vs 2 cases)and operation time(≥3 d 26 cases vs 6 cases),had a bigger effect on the prognosis of patients,and the differences were obvious with statistical significance(P<0.01),and the multiple-factor analysis results showed that the age,ASA typing were the independent influence factors,and the differences were statistically significant(P<0.05),but the clinical AO typing,fracture stability and opportunity time were the non-independent influence factors and the differences were not statistically significant(P>0.05).Conclusion The age and operation time are the risk factors of curative effect after the non-union of senile femoral intertrochanteric fractures after the PFNA internal fixation surgery,but the AO typing,ASA typing and fracture stability can have different degrees of effects on the prognosis.