老年股骨转子间骨折患者PFNA内固定的手术时机探讨及术后髋关节功能恢复的影响因素分析

Discussion on the Operation Time of PFNA Internal Fixation in Elderly Patients with Femoral Intertrochanteric Fracture and Analysis of the Influencing Factors of Postoperative Hip Function Recovery

目的:探讨老年股骨转子间骨折患者股骨近端防旋髓内钉(PFNA)内固定的最佳手术时机,并分析术后髋关节功能恢复的影响因素。方法:选取我院2018年7月~2021年8月期间收治的老年股骨转子间骨折患者128例作为研究对象,根据手术时机的不同分为早期组(n=61,骨折后48 h内进行手术)和延期组(n=67,骨折后48 h后进行手术),比较两组手术相关指标、并发症发生情况和术后6个月髋关节功能恢复优良率。此外,根据髋关节功能恢复情况将128例患者分为优良组(优、良)和不良组(可、差),对比两组临床资料,采用多因素Logistic回归分析术后髋关节功能恢复的影响因素。结果:术后6个月,早期组的髋关节功能恢复优良率高于延期组(P<0.05)。早期组的手术时间、住院时间短于延期组,术中出血量、输血量、住院费用少于延期组(P<0.05)。早期组的并发症总发生率低于延期组(P<0.05)。多因素Logistic回归分析结果显示:年龄≥70岁、外侧壁分型为Ⅲ型、下地负重时间≥30 d、Evans分型为不稳定型、骨密度为T<-2.5SD、ASA分级为Ⅱ级是术后髋关节功能恢复不良的危险因素,而手术时机为早期则是术后髋关节功能恢复不良的保护因素(P<0.05)。结论:相较于延期手术,伤后早期接受PFNA内固定治疗更能促进老年股骨转子间骨折患者髋关节功能恢复,恢复效果同时也受到年龄、外侧壁分型、下地负重时间、Evans分型、骨密度、ASA分级等因素影响。

Objective: To explore the best operation time of proximal femoral anti rotation intramedullary nail(PFNA) internal fixation in elderly patients with femoral intertrochanteric fracture, and to analyze the influencing factors of postoperative hip function recovery. Methods: 128 elderly patients with femoral intertrochanteric fracture who were received in our hospital from July 2018 to August 2021 were selected as the research objects. All patients were divided into early group(n=61, operation within 48 after fracture) and delayed group(n=67, operation after 48 after fracture) according to different operation time. The operation related indexes, the incidence of complications and the excellent and good rate of hip function recovery 6 months after operation were compared between the two groups. In addition, according to the recovery of hip function, 128 patients were divided into excellent and good group(excellent and good) and poor group(acceptable and poor). The clinical data of the two groups were compared, and the influencing factors of postoperative hip function recovery were analyzed by multivariate Logistic regression. Results: 6 months after operation, the excellent and good rate of hip function recovery in the early group was higher than that in the delayed group(P<0.05). The operation time and hospital stay in the early group were shorter than those in the delayed group, and the amount of intraoperative bleeding, blood transfusion and hospitalization expenses in the early group were less than those in the delayed group(P<0.05). The total incidence of complications in the early group was lower than that in the delayed group(P<0.05). Multivariate Logistic regression analysis showed that age ≥70 years, the lateral wall classification type Ⅲ, ground load-bearing time ≥30 d, Evans type was unstable, bone mineral density T <-2.5SD and ASA grade was Ⅱ were the risk factors of poor postoperative hip function recovery, while the operation time early was the protective factor of poor postoperative hip function recovery(P<0.05). Conclusion: Compared with delayed operation, early PFNA internal fixation after injury can better promote the recovery of hip function in elderly patients with femoral intertrochanteric fracture. The recovery effect is affected by age, lateral wall classification, weight-bearing time, Evans classification, bone mineral density, ASA classification and other factors.