不稳定股骨粗隆间骨折PFNA-Ⅱ术后效果的影响因素分析

Analysis of influencing factors of the postoperative effect of unstable intertrochanteric fractures of PFNA-Ⅱ

目的探讨不稳定股骨粗隆间骨折PFNA-Ⅱ术后效果的影响因素。方法选取2016年1月—2019年1月于浙江省人民医院淳安分院行PFNA-Ⅱ的不稳定股骨粗隆间骨折患者63例,术后随访1年,根据术后髋关节Harris功能评分,分为优良组(Harris评分≥80分)和不良组(Harris评分<80分),对比2组患者一般资料及手术相关指标的差异,并行多因素logistic回归分析。结果随访过程中有1例患者失访,剩余62例患者末次随访时,42例Harris评分≥80分列为优良组,其余20例Harris评分<80分列为不良组,术后髋关节功能不良率为32.26%(20/62);比较2组BMI(25.31±4.63 vs.27.96±4.72)、骨质疏松比例(47.62%vs.85.00%)、尖顶距[(24.43±1.65)mm vs.(26.84±2.18)mm]、外侧壁分型(Ⅰ~Ⅲ型,分别为61.90%、33.33%、4.76%vs.30.00%、40.00%、30.00%)、外侧壁厚度[(2.43±0.39)mm vs.(2.05±0.31)mm],差异均有统计学意义(均P<0.05);多因素logistic回归分析结果显示:尖顶距、外侧壁分型、外侧壁厚度(均P<0.05)可能是PFNA-Ⅱ术后髋关节功能的独立影响因素。结论尖顶距大、外侧壁完整性差及外侧壁薄是不稳定股骨粗隆间骨折PFNA-Ⅱ术后髋关节功能不良的独立危险因素。

Objective To explore the factors affecting the effect of PFNA-Ⅱafter unstable femoral intertrochanteric fractures.Methods A total of 63 patients with unstable femoral intertrochanteric fractures who underwent PFNA-Ⅱat the Chun’an Branch of Zhejiang Provincial People’s Hospital from January 2016 to January 2019 were followed up for 1 year.According to the Harris function score of the hip joint after surgery,the patients were divided into the good group(Harris score≥80 points)and poor group(Harris score<80 points).The differences in general information and surgery-related indicators between the two groups were compared,and multivariate logistic regression analysis was performed.Results During the follow-up,1 patient was lost to follow-up.At the last follow-up of the remaining 62 patients,42 patients with Harris score≥80 were classified as the good group,and the remaining 20 patients with Harris score<80 were classified as the poor group.The rate of postoperative hip dysfunction was 32.26%(20/62).There were significant differences in BMI(25.31±4.63 vs.27.96±4.72),osteoporosis ratio(47.62%vs.85.00%),apex distance[(24.43±1.65)mm vs.(26.84±2.18)mm],lateral wall classification(typeⅠ-Ⅲ,fractions are 61.90%,33.33%,4.76%vs.30.00%,40.00%,30.00%),thickness of outer wall[(2.43±0.39)mm vs.(2.05±0.31)mm]between the two groups(all P<0.05).The results of multivariate logistic regression analysis showed that the apex distance,lateral wall type and lateral wall thickness were independent influencing factors of hip joint function after PFNA-Ⅱoperation(all P<0.05).Conclusion The large apex distance,poor integrity of the lateral wall and thin lateral wall are independent risk factors for hip dysfunction after PFNA-Ⅱoperation for unstable femoral intertrochanteric fractures.