股骨近端防旋髓内钉固定股骨粗隆间骨折失败的因素△

Risk factors of proximal femoral nail anti- rotation failure for femoral intertrochanteric fractures

摘要:

［目的］ 探讨股骨近端防旋髓内钉 （proximal femoral nail anti-rotation, PFNA） 固定股骨粗隆间骨折失败的相关因素。 ［方法］回顾性分析 2017 年 1 月—2020 年 1 月本院采用 PFNA 固定股骨粗隆间骨折的 110 例患者的临床资料。按随访过程中是否发生内固定失败将其分为失败组和成功组，采用单项因素比较和二元多因素逻辑回归分析探索内固定失败的因素。［结果］ 110 例患者均顺利完成手术，随访 12~16 个月。随访过程中，共 12 例发生内固定失败，占 10.91%；其余 98 例均获得成功，占比 89.09%。按是否发生内固定失败将患者分为两组，两组性别、年龄、体重指数、损伤侧别、TAD 的差异均无统计学意义 （P>0.05）。但是，失败组外侧壁不完整比率显著高于成功组（P<0.05），失败组对线差比率显著大于成功组（P<0.05），失败组的内侧皮质阴性支撑比率显著高于成功组（P<0.05），失败组的螺钉位置差的比率显著高于成功组（P<0.05）。多因素逻辑回归表明：外侧壁不完整 （OR=14.424，P=0.007）、复位对线差 （OR=6.578，P=0.033）、内侧皮质阴性支撑 （OR=17.17，P= 0.005）、螺旋刀片位置差 （OR=8.403，P=0.038） 是导致内固定手术失败的独立危险因素。［结论］ 外侧壁不完整、复位对线差、内侧皮质阴性支撑、螺旋刀片位置差是导致手术失败的危险因素。

Abstract:

[Objective] To explore the risk factors of proximal femoral nail anti-rotation (PFNA) failure for internal fixation of femoral intertrochanteric fractures. [Methods] A retrospective study was performed on 110 patients who received PFNA for femoral intertrochanter- ic fractures in our hospital from January 2017 to January 2020. The patients were divided into failure group and success group according to whether internal fixation failure occurred during follow-up. Univariate comparison and binary multiple logistic regression analysis were con- ducted to explore the risk factors of the internal fixation failure. [Results] All the 110 patients had PFNA fixation performed smoothly, and were followed up for 12~16 months. During follow-up, 12 patients were proved internal fixation failure, accounting for 10.91%, while the re- maining 98 patients got successful fixation, accounting for 89.09%. Patients were divided into two groups according to whether internal fixa- tion failure occurred. There were no significant differences in gender, age, body mass index, side of injury, tip-apex distance (TAD) be- tween the two groups (P>0.05) . However, the failure group had a significantly higher ratio of incomplete lateral wall (P<0.05) , significantly higher ratio of poor fracture alignment (P<0.05) , significantly higher ratio of the negative support of medial cortex (P<0.05) , and signifi- cantly higher ratio of poor spiral blade placement than the success group (P<0.05) . As result of multivariate logistic regression, the incom- plete lateral wall (OR=14.424, P=0.007) , poor fracture alignment (OR=6.578, P=0.033) , negative support of medial cortex (OR=17.17, P= 0.005) , and poor spiral blade placement (OR=8.403, P=0.005, P=0.038) were the independent risk factors for internal fixation failure. [Conclusion] Incomplete lateral wall, poor reduction alignment, negative medial cortical support, and poor position of spiral blade are risk factors for PFNA failure.