髋关节置换术治疗股骨转子间骨折疗效及预后分析

Analysis of clinical efficacy and prognostic factors in the treatment ofintertrochanteric fractures with hip arthroplasty

目的 分析利用髋关节置换手术治疗股骨转子间骨折的临床疗效,并探讨影响术后疗效因素。方法 对2012年11月至2022年8月本院收治的96例老年不稳定型股骨转子间骨折(intertrochanteric fracture,IF)患者进行回顾性分析,评价其术后疗效。男28例,女68例,年龄在61~94岁,平均年龄81.78岁。所有入组患者均采用髋关节置换手术进行治疗,随访资料完整。将其分为新鲜股骨转子间骨折手术组(F-IF组,82例)及陈旧性股骨转子间骨折手术组(O-IF组,14例),临床疗效评定从术后末次随访时病死率、术后至少半年髋关节功能Harris评分方面进行评定。将可能与预后相关因素(性别、年龄、术前病程长短、骨折分型、是否合并陈旧骨折、全髋或半髋置换术、术后是否输血、术前合并基础疾病数目、是否并发症、并发症数目、影像学是否用钢丝捆扎大小转子)纳入单因素研究。再以是否为陈旧性股骨转子间骨折为因变量进行赋值分组(是用“1”表示,否用“0”表示),以上述纳入因素为协变量,再将单因素分析有统计学意义的危险因素进行二元Logistic回归分析,进一步分析影响患者预后的危险因素。结果 96例患者均获得随访,随访时间6个月至10年。随访半年至1年内病死率10.4%(10/96)。术后输血率75%,并发症总体发生率65.6%。对术后髋关节功能与术前进行对比,采用独立样本t检验,差异具有统计学意义(P<0.001)。对F-IF和O-IF进行分组比较,进行ANOVA单因素检验,得出术前病程长短(P<0.001)、手术中对大小转子进行捆扎固定(P=0.038)、实施全髋关节置换手术(P=0.002)是预后相关因素。进一步二元Logistic回归分析显示对股骨转子间骨折患者实施全髋关节置换术(P=0.010)是影响术后疗效的独立危险因素。结论 利用髋关节置换术处理不稳定型股骨转子间骨折手术取得满意疗效,但术后总体输血率高,总体并发症发生率高。其中对股骨转子间骨折患者进行全髋关节置换术为影响预后重要因素。

Objective To analyze the clinical efficacy of hip arthroplasty for the intertrochanteric fracture,and to explore factors that may af-fect the postoperative clinical efficacy.Methods A retrospective analysis was conducted on 96 elderly patients with femoral intertrochanteric frac-tures admitted to our department from November 2012 to August 2022 to evaluate their postoperative efficacy.There were 28 males and 68 females,with an average age of 81.78 years,ranging from 61 to 94 years old.All enrolled patients were treated with hip replacement surgery,with complete follow-up data.They were divided into two groups:Fresh intertrochanteric fracture surgery group(F-IF group,82) and Old intertrochanteric fracture surgery group(O-IF group,14).The clinical efficacy was evaluated in terms of mortality at the last follow-up after surgery and Harris score of hip joint function at least half a year after surgery.Factors that may be related to prognosis(Gender,age,preoperative course of disease,fracture classification,whether old fractures are associated,total or half hip replacement surgery,whether blood transfusion performed after surgery,the number of preopera-tive underlying diseases,whether complications,the number of complications,and whether large and small tuberosities bound with steel wire in imag-ing) were included in a univariate study.Then,whether it is an old intertrochanteric fracture of the femur wa assigned as a dependent variable for grouping(whether it is represented by "1" or not is represented by "0"),and the above included factors were used as covariates.Then,the statistically significant risk factors in univariate analysis were analyzed using binary logistic regression analysis to further analyze the risk factors that affect the prognosis of the patient.Results All 96 patients were followed up for 6 months to 10 years.The mortality rate within half one year of follow-up was 10.4%(10/96).The postoperative blood transfusion rate was 75%,and the overall incidence of complications was 65.6%.The function of the hip joint after surgery was compared with that before surgery using an independent sample T-test,with a P value of 0.00,which was statistically signifi-cant.By grouping and comparing F-IF and O-IF,and conducting ANOVA univariate test,it was concluded that preoperative course length( P=0.00),intraoperative fixation of large and small tuberosities(P=0.038),and total hip replacement surgery(P=0.002) were prognostic factors.Further Binary Logistic Regression Analysis showed that total hip arthroplasty(P=0.010) for patients with femoral intertrochanteric fractures was an independent risk factor affecting postoperative outcomes.Conclusion The treatment of femoral intertrochanteric fractures with hip replacement has achieved satisfac-tory results,but the overall postoperative blood transfusion rate is high and the overall complication rate is high.Total hip arthroplasty for patients with intertrochanteric fractures is an important prognostic factor.