老年股骨转子间骨折患者BMI与PFNA型号选择的相关性研究

Correlation between BMI and PFNA size selection in elderly patients with femoral intertrochanteric fractures

目的探讨应用股骨近端防旋髓内钉(PFNA)治疗老年股骨转子间骨折患者的BMI与PFNA型号之间的相关性。方法回顾性分析2016年12月—2020年7月济宁医学院附属医院创伤骨科行手术治疗的老年股骨转子间骨折患者207例。根据笔者医院海泰V3.0电子病历系统软件采集的患者身高、体重信息,计算得出BMI数值,按照BMI的中国参考标准进行分组:正常及体重不足组为A组[包括体重不足(BMI<18.5 kg/m^(2))和正常(18.5≤BMI<24 kg/m^(2))]135例,男57例,女78例;超重及肥胖组为B组[包括超重(24≤BMI<28 kg/m^(2))和肥胖(BMI≥28kg/m^(2))]72例,男15例,女57例;分析每组患者手术时间、住院时间、术中出血及选择的PFNA型号。结果本组患者经门诊或电话随访1年,均健在,且未发生内固定物松动、骨折不愈合等并发症。A组患者的平均年龄(80.0±8.2)岁大于B组(79.7±8.9)岁,术中出血量(128.4±113.5)mL多于B组(120.1±84.8)mL,螺旋刀片长度(92.0±7.3)mm长于B组(89.0±32.0)mm,主钉直径(11.0±0.83)mm大于B组(10.7±0.9)mm;其中主钉直径差异有统计学意义(P<0.05)。A组平均住院时间(13.8±5.2)d、手术时间(66.5±31.4)mim均短于B组住院时间(15.7±9.6)d、手术时间(75.7±22.0)min,A组主钉长度(184.7±25.3)mm短于B组(189.7±38.4)mm,其中手术时间比较差异有统计学意义(P<0.05)。结论老年股骨转子间骨折患者的BMI与PFNA型号之间存在一定的相关性,BMI值在正常及体重不足患者应用主钉的直径显著大于超重及肥胖患者,且手术时间明显短于超重及肥胖患者。

Objective To explore the correlation between body mass index(BMI)and proximal femoral nail anti-rotation(PFNA)size in the treatment of elderly patients with intertrochanteric fractures.Methods A total of 207 elderly patients with intertrochanteric fractures who underwent surgical treatment in the Department of Orthopaedics,Jining Medical University from Dec.2016 to Jul.2020 were retrospectively analyzed.According to the height and weight information collected by the Haitai V3.0 electronic medical record system,the BMI was calculated.Based on the Chinese BMI standard,patients were divided into group A(underweight and normal with a BMI<24 kg/m^(2))and group B(overweight and obesity with a BMI≥24 kg/m^(2)).There were 135 cases in group A,including 57 males and 78 females aged 80.0 years on average,and 72 cases in group B,including 15 males and 57 females aged 79.7 on average.The operation time,length of hospital stay,intraoperative bleeding and PFNA nail size were analyzed.Results The 207 cases of femoral intertrochanteric fractures were followed up for 1 year by outpatient service or telephone.All of them survived and no complication of loosening or nonunion was observed.Compared with group B,group A showed significantly shorter operation time(min,66.5±31.4 vs.75.7±22.0,P=0.036)and larger diameter of the main nail(mm,11.0±0.83 vs.10.7±0.9,P=0.028).Other variables revealed no significant difference between groups A and B:intraoperative bleeding(mL,128.4±113.5 vs.120.1±84.8),hospitalization time(d,13.8±5.2 vs.15.7±9.6),and length of the spiral blade(mm,92.0±7.3 vs.89.0±32.0)and the main nail(mm,184.7±25.3 vs.189.7±38.4,all P>0.05).Conclusion There is a certain correlation between BMI and PFNA size in elderly patients with intertrochanteric fractures.The diameter of the main nail used in normal and underweight patients is significantly larger than that in overweight and obese patients,and the operation time is significantly shorter.