老年股骨转子间骨折髓内钉内固定术后髋关节功能恢复不良的相关因素分析
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摘要
目的研究老年股骨转子间骨折髓内钉内固定术后髋关节功能恢复不良的相关因素。方法选取2015年3月～2017年3月盘锦市中心医院收治的老年股骨转子间骨折患者129例进行研究,所有患者均接受髓内钉内固定治疗。对所有患者进行为期1年的随访观察,并根据Maryland足部功能评分将其分为功能恢复良好组(95例,良好组)以及功能恢复不良组(34例,不良组)。分别比较两组患者各项基本资料以及术后恢复情况,并予以多因素的Logistic回归分析。结果良好组年龄较不良组明显更低,骨密度T≥-2.5 SD、血浆白蛋白含量水平≥30 g/L、美国麻醉医师协会(ASA)分级为P1～P2人数百分比较不良组明显更高(均P <0.05)。与良好组复位满意、康复师康复人数百分比比较,不良组较低,术后并发症比较,不良组较高(均P <0.05)。经多因素Logistic回归分析可得:年龄≥70岁、骨密度T<-2.5 SD、ASA分级P3～P4级、血浆白蛋白含量水平<30 g/L、无康复师康复、复位不满意、围术期有并发症均是老年股骨转子间骨折髓内钉内固定术后髋关节功能恢复不良的独立危险因素(均P <0.05)。结论老年股骨转子间骨折髓内钉内固定术后髋关节功能恢复不良的相关因素包括年龄、骨密度、ASA分级、血浆白蛋白含量水平、康复师康复、骨折复位、围术期并发症等,临床工作中可针对上述因素予以相关措施干预,从而达到改善患者术后髋关节功能的目的。
Objective To investigate the related factors of poor recovery of hip joint function after intramedullary nailing in elderly patients with intertrochanteric fracture. Methods A total of 129 elderly patients with femoral intertrochanteric fractures admitted to Panjin Central Hospital from March 2015 to March 2017 were selected for study.All patients were treated with intramedullary nailing. All patients were followed up for one year and divided into the group with good functional recovery(95 cases, good group) and the group with poor functional recovery(34 cases, adverse group) according to Maryland foot function score. Basic data and postoperative recovery were compared between the two groups, and multivariate Logistic regression analysis was performed. Results The age of the good group was significantly lower than that of the adverse group, and the bone mineral density T ≥-2.5 SD, plasma albumin level ≥ 30 g/L, and the number of patients classified as P1-P2 by American seciety of anesthesiologists(ASA) was significantly higher than that of the adverse group(all P < 0.05). Compared with the good group, the percentage of patients with satisfactory reduction and recovery was higher in the adverse group, and the postoperative complications were lower in the adverse group(all P < 0.05). After multiariable Logistic regression analysis available: age ≥70, bone mineral density T<-2.5 SD, ASA grade P3-P4 level, plasma albumin levels < 30 g/L, no Kangfushi rehabilitation and reset dissatisfied, perioperative complications were elderly femoral fracture internal fixation with intramedullary nail between rotor independent risk factors for poor recovery of hip joint function(all P < 0.05). Conclusion Elderly femoral fracture internal fixation with intramedullary nail between rotor poor recovery of hip function related factors including age, bone mineral density, ASA sizing, plasma albumin levels, Kangfushi rehabilitation, fracture, perioperative complications, such as clinical work should be related intervention measures in view of the above factors, so as to achieve the goal of improve patients postoperative hip joint function.
Objective To investigate the related factors of poor recovery of hip joint function after intramedullary nailing in elderly patients with intertrochanteric fracture. Methods A total of 129 elderly patients with femoral intertrochanteric fractures admitted to Panjin Central Hospital from March 2015 to March 2017 were selected for study.All patients were treated with intramedullary nailing. All patients were followed up for one year and divided into the group with good functional recovery(95 cases, good group) and the group with poor functional recovery(34 cases, adverse group) according to Maryland foot function score. Basic data and postoperative recovery were compared between the two groups, and multivariate Logistic regression analysis was performed. Results The age of the good group was significantly lower than that of the adverse group, and the bone mineral density T ≥-2.5 SD, plasma albumin level ≥ 30 g/L, and the number of patients classified as P1-P2 by American seciety of anesthesiologists(ASA) was significantly higher than that of the adverse group(all P < 0.05). Compared with the good group, the percentage of patients with satisfactory reduction and recovery was higher in the adverse group, and the postoperative complications were lower in the adverse group(all P < 0.05). After multiariable Logistic regression analysis available: age ≥70, bone mineral density T<-2.5 SD, ASA grade P3-P4 level, plasma albumin levels < 30 g/L, no Kangfushi rehabilitation and reset dissatisfied, perioperative complications were elderly femoral fracture internal fixation with intramedullary nail between rotor independent risk factors for poor recovery of hip joint function(all P < 0.05). Conclusion Elderly femoral fracture internal fixation with intramedullary nail between rotor poor recovery of hip function related factors including age, bone mineral density, ASA sizing, plasma albumin levels, Kangfushi rehabilitation, fracture, perioperative complications, such as clinical work should be related intervention measures in view of the above factors, so as to achieve the goal of improve patients postoperative hip joint function.
引文
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[2]朱卫洁,王晓芳,申友亮,等.早期闭合复位PFNA内固定治疗老年股骨转子间骨折[J].中国矫形外科杂志,2018,26(6):520-523.
[3]管戈,王开舫.Gamma3型带锁髓内钉治疗老年股骨转子间骨折70例疗效分析[J].中国医刊,2018,53(7):737-739.
[4]王正,谢益敏,李贵勇,等.剪刀体位下髓内钉内固定治疗老年股骨转子间骨折[J].中医正骨,2018,30(5):53-55.
[5]林凤飞,陈宾,林朝晖,等.老年股骨转子间骨折无牵引床侧卧位股骨近端抗旋髓内钉固定的手术技巧[J].中华骨科杂志,2018,38(13):796-804.
[6]刘俊建.骨折诊治临床指南[J].第二军医大学学报,2014,35(7):807.
[7]瞿浩.SandersⅢ型跟骨骨折解剖学指标改变与术后疗效的相关性分析[D].武汉:湖北中医药大学,2014.
[8]王路,林文军,朱雄白,等.Wagner SL假体柄半髋置换术治疗内固定失败的高龄股骨转子间骨折[J].中华创伤杂志,2018,34(8):728-733.
[9]王卫军.股骨近端防旋髓内钉与锁定钢板内固定治疗股骨转子间骨折临床疗效比较[J].中国临床新医学,2018,11(5):469-472.
[10]张文强.髋关节置换术与近端防旋髓内钉内固定术对老年股骨转子间骨折患者功能恢复的前瞻性研究[J].中国骨与关节杂志,2018,7(10):778-782.
[11]周永红.股骨近端抗旋髓内钉内固定治疗54例股骨转子间骨折老年患者的短、中期随访研究及髋关节功能分析[J].现代医用影像学,2018,27(4):1256-1257.
[12]马晓飞,张浩,代僚原,等.不同手术方案治疗高龄严重骨质疏松性股骨转子间骨折的临床研究[J].现代实用医学,2018,30(2):174-176.
[13]丁海祥,孙强,董新利,等.老年不稳定股骨转子间骨折手术内固定材料的选择[J].临床骨科杂志,2018,21(1):101-104.
[14]王玮,沈惠良,安帅,等.股骨近端髓内钉治疗老年难复位型股骨转子间骨折的相关因素分析[J].北京医学,2016,38(5):444-448.
[15]邓宁,矫昌勋,李元耿,等.股骨近端抗旋髓内钉-Ⅱ治疗老年不稳定型股骨转子间骨折疗效及影响因素分析[J].中华临床医师杂志:电子版,2013,33(11):5088-5090.
[16]冯明利,沈惠良,雍宜民,等.影响股骨转子间骨折患者髋关节预后功能的相关因素[J].中国临床康复,2004,8(23):4857-4859.
[17]黄鑫,苏柯,王晓宁,等.围手术期内科并存病对高龄股骨转子间骨折术后疗效的影响[J].中华老年骨科与康复电子杂志,2017,3(1):11-16.
[18]Yoo JI,Lee YK,Koo KH,et al.Concerns for Older Adult Patients with Acute Hip Fracture[J].Yonsei Med J,2018,59(10):1240-1244.
[19]邹毅,叶茂,何玲莉,等.老年转子间骨折PFNA内固定术后髋关节功能的影响因素分析[J].创伤外科杂志,2018,20(8):583-586.
[20]陆永刚,樊健.Gotfried支撑复位结合内固定对中青年股骨颈骨折患者髋关节功能及血流动力学的影响[J].中国现代医学杂志,2017,27(24):96-100.
[2]朱卫洁,王晓芳,申友亮,等.早期闭合复位PFNA内固定治疗老年股骨转子间骨折[J].中国矫形外科杂志,2018,26(6):520-523.
[3]管戈,王开舫.Gamma3型带锁髓内钉治疗老年股骨转子间骨折70例疗效分析[J].中国医刊,2018,53(7):737-739.
[4]王正,谢益敏,李贵勇,等.剪刀体位下髓内钉内固定治疗老年股骨转子间骨折[J].中医正骨,2018,30(5):53-55.
[5]林凤飞,陈宾,林朝晖,等.老年股骨转子间骨折无牵引床侧卧位股骨近端抗旋髓内钉固定的手术技巧[J].中华骨科杂志,2018,38(13):796-804.
[6]刘俊建.骨折诊治临床指南[J].第二军医大学学报,2014,35(7):807.
[7]瞿浩.SandersⅢ型跟骨骨折解剖学指标改变与术后疗效的相关性分析[D].武汉:湖北中医药大学,2014.
[8]王路,林文军,朱雄白,等.Wagner SL假体柄半髋置换术治疗内固定失败的高龄股骨转子间骨折[J].中华创伤杂志,2018,34(8):728-733.
[9]王卫军.股骨近端防旋髓内钉与锁定钢板内固定治疗股骨转子间骨折临床疗效比较[J].中国临床新医学,2018,11(5):469-472.
[10]张文强.髋关节置换术与近端防旋髓内钉内固定术对老年股骨转子间骨折患者功能恢复的前瞻性研究[J].中国骨与关节杂志,2018,7(10):778-782.
[11]周永红.股骨近端抗旋髓内钉内固定治疗54例股骨转子间骨折老年患者的短、中期随访研究及髋关节功能分析[J].现代医用影像学,2018,27(4):1256-1257.
[12]马晓飞,张浩,代僚原,等.不同手术方案治疗高龄严重骨质疏松性股骨转子间骨折的临床研究[J].现代实用医学,2018,30(2):174-176.
[13]丁海祥,孙强,董新利,等.老年不稳定股骨转子间骨折手术内固定材料的选择[J].临床骨科杂志,2018,21(1):101-104.
[14]王玮,沈惠良,安帅,等.股骨近端髓内钉治疗老年难复位型股骨转子间骨折的相关因素分析[J].北京医学,2016,38(5):444-448.
[15]邓宁,矫昌勋,李元耿,等.股骨近端抗旋髓内钉-Ⅱ治疗老年不稳定型股骨转子间骨折疗效及影响因素分析[J].中华临床医师杂志:电子版,2013,33(11):5088-5090.
[16]冯明利,沈惠良,雍宜民,等.影响股骨转子间骨折患者髋关节预后功能的相关因素[J].中国临床康复,2004,8(23):4857-4859.
[17]黄鑫,苏柯,王晓宁,等.围手术期内科并存病对高龄股骨转子间骨折术后疗效的影响[J].中华老年骨科与康复电子杂志,2017,3(1):11-16.
[18]Yoo JI,Lee YK,Koo KH,et al.Concerns for Older Adult Patients with Acute Hip Fracture[J].Yonsei Med J,2018,59(10):1240-1244.
[19]邹毅,叶茂,何玲莉,等.老年转子间骨折PFNA内固定术后髋关节功能的影响因素分析[J].创伤外科杂志,2018,20(8):583-586.
[20]陆永刚,樊健.Gotfried支撑复位结合内固定对中青年股骨颈骨折患者髋关节功能及血流动力学的影响[J].中国现代医学杂志,2017,27(24):96-100.