股骨近端防旋髓内钉内固定治疗老年股骨转子间骨折的效果及影响因素分析

Analysis of therapeutic effect and related influencing factors of nail internal fixation in treatment of elderly intertrochanteric fracture

目的探讨股骨近端防旋髓内钉(PFNA)内固定治疗老年股骨转子间骨折的效果及相关影响因素。方法回顾性分析2018-08—2019-08天津市永久医院骨科行PFNA内固定治疗的110例老年股骨转子间骨折患者资料。术后1 a采用Harris髋关节评分表评价患者的髋关节功能。并对患者的年龄、性别、合并内科疾病、骨折分型、外侧壁分型、下地负重时间、手术时间进行单因素分析筛选影响因素,对P>0.05的因素再采用多因素Logistic回归分析确定主要的独立影响因素。结果110例患者中84例(76.36%)恢复良好(Harris评分≥60分),26例(23.64%)恢复不良(Harris评分<60分)。单因素分析结果显示:恢复良好患者和恢复不良患者的性别、合并内科疾病差异无统计学意义(P>0.05)。多因素Logistic回归分析显示:年龄≥80岁、不稳定型骨折、Ⅱ型、Ⅲ型外侧壁分型、下地负重时间≥30 d是影响老年股骨转子间骨折患者PFNA内固定效果的独立因素。结论年龄≥80岁、不稳定型骨折、Ⅱ型、Ⅲ型外侧壁分型、下地负重时间≥30 d是影响老年股骨转子间骨折患者PFNA内固定效果的独立因素。

Objective The effect of proximal intramedullary nail(PFNA)in the treatment of interfemoral rotor fracture and related factors were discussed.Methods Data of 110 elderly patients with interfemoral rotor fractures treated with PFNA internal fixation in the Department of Orthopedics of Tianjin Permanent Hospital from 2018-08 to 2019-08.Postoperative 1 year used the Harris hip score table to evaluate the patient's hip function.The influencing factors were analyzed for patient age,sex,medical diseases,fracture classification,fracture division,lateral wall division,lower loading time and operation time,and multiple factors of P>0.05 were used to determine the main independent influencing factors.Results Totally 84 of 110 patients(76.36%)recovered well(Harris score≥60)and 26(23.64%)(Harris score<60).Single-factor analysis showed no statistical difference in patients with poor recovery(P>0.05).Multi-factor Logistic regression analysis showed that age≥80 years,unstable fracture,type,lateral wall division,lower bearing time of≥30 d are independent factors affecting the PFNA fixation effect in elderly femoral interfemur fracture.Conclusion Age≥80,unstable fracture,type,lateral wall division,and ground bearing time≥30 d are independent factors affecting PFNA fixation in elderly patients with femur rotor fractures.