CAJ | 학술논문

目的探讨老年骨质疏松性股骨转子间骨折术后内固定失败的影响因素. 方法回顾性分析2006年1月至2011年9月采用切开复位内固定治疗且获得随访的219例老年骨质疏松性股骨转子间骨折患者资料,男98例,女121例;年龄为65～ 99岁,平均77.8岁.记录患者内固定失败的发生率及末次随访时髋关节Harris评分.统计可能对内固定失败产生影响的因素,并对影响内固定失败的各项因素(P＜0.05)进行多因素logistic回归分析. 结果 219例患者术后获平均42个月(24 ～ 70个月)随访.41例患者出现内固定失败,发生率为18.7％.末次随访时髋关节Harris评分平均为82.7分(58 ～94分);优33例,良145例,可12例,差29例,优良率为81.3％.多因素logistic回归分析结果显示:不稳定型骨折[OR =9.183,95％ CI(1.453,14.212),P=0.013]、重度骨质疏松[OR=8.941,95％ CI(1.328,13.871),P=0.015]、外侧壁骨折[OR=7.097,95％ CI(1.107,7.481),P=0.020]、合并内科疾病[OR=5.954,95％CI(0.926,5.609),P=0.027]、功能复位[OR=5.198,95％CI(1.052,4.857),P=0.034]和尖顶距＞25 mm[OR=3.627,95％CI(0.501,6.149),P=0.041]是内固定失败的独立危险因素. 结论骨折不稳定是影响股骨转子间骨折术后内固定失败最为关键的因素.严重骨质疏松、外侧壁骨折、功能复位、合并内科疾病及尖顶距＞ 25 mm均可能导致内固定失败.
목적 탐토노년골질소송성고골전자간골절술후내고정실패적영향인소. 방법 회고성분석2006년1월지2011년9월채용절개복위내고정치료차획득수방적219례노년골질소송성고골전자간골절환자자료,남98례,녀121례;년령위65～ 99세,평균77.8세.기록환자내고정실패적발생솔급말차수방시관관절Harris평분.통계가능대내고정실패산생영향적인소,병대영향내고정실패적각항인소(P＜0.05)진행다인소logistic회귀분석. 결과 219례환자술후획평균42개월(24 ～ 70개월)수방.41례환자출현내고정실패,발생솔위18.7％.말차수방시관관절Harris평분평균위82.7분(58 ～94분);우33례,량145례,가12례,차29례,우량솔위81.3％.다인소logistic회귀분석결과현시:불은정형골절[OR =9.183,95％ CI(1.453,14.212),P=0.013]、중도골질소송[OR=8.941,95％ CI(1.328,13.871),P=0.015]、외측벽골절[OR=7.097,95％ CI(1.107,7.481),P=0.020]、합병내과질병[OR=5.954,95％CI(0.926,5.609),P=0.027]、공능복위[OR=5.198,95％CI(1.052,4.857),P=0.034]화첨정거＞25 mm[OR=3.627,95％CI(0.501,6.149),P=0.041]시내고정실패적독립위험인소. 결론 골절불은정시영향고골전자간골절술후내고정실패최위관건적인소.엄중골질소송、외측벽골절、공능복위、합병내과질병급첨정거＞ 25 mm균가능도치내고정실패.
Objective To retrospectively study the factors which contribute to the failed internal fixation of osteoporotic femoral intertrochanteric fractures in the elderly patients.Methods A total of 219 elderly patients with osteoporotic femoral intertrochanteric fracture were treated by open reduction and internal fixation from January 2006 to September 2011.They were 98 males and 121 females,aged from 65 to 99 years (average,77.8 years).The incidence of failed fixation and the Harris hip scores at the last follow-up were documented.The factors which might have contributed to the failure were analyzed by SPSS20.0.The logistic multiple regression was used to analyze the influencing factors related to the failed internal fixation (P ＜ 0.05).Results The 219 patients obtained a mean follow-up of 42 months (from 24 to 70 months).Failed internal fixation occurred in 41 cases (18.7％).The Harris hip scores at the last follow-up averaged 82.7 points (from 58 to 94 pints).There were 33 excellent,145 good,12 fair and 29 poor cases,giving an excellent to good rate of 81.3％.Logistic regression analyses found unstable fracture [OR =9.183,95％ CI (1.453,14.212),P=0.013],severeosteoporosis [OR =8.941,95％ CI (1.328,13.871),P =0.015],lateral femoral wall fracture [OR =7.097,95％ CI (1.107,7.481),P =0.020],concomitant internal disease [OR =5.954,95％ CI (0.926,5.609),P =0.027],non-anatomic reduction [OR =5.198,95％ CI (1.052,4.857),P =0.034] and tip-apex distance (TAD) [OR =3.627,95％ CI (0.501,6.149),P =0.041] to be the independent risk factors which had been significantly associated with failed internal fixation.Conclusions Unstability of the fracture is the most crucial factor that may lead to failed fixation in the treatment of osteoporotic femoral intertrochanteric fracture in the elderly patients.Severe osteoporosis,lateral femoral wall fracture,concomitant internal disease and great TAD may also increase the risk of failed internal fixation.