老年股骨粗隆间骨折PFNA术后内固定周围再骨折相关影响因素分析

刘少峥 李跃军 李雪栋

【摘要】 目的 分析老年股骨粗隆间骨折股骨近端抗旋转髓内钉（PFNA）内固定术后周围再骨折的相关影响因素。

方法 选取2019年1月至2020年2月收治的120例老年股骨粗隆间骨折患者作为研究对象。患者均实施股骨粗隆间骨折PFNA术，术后有45例患者发生内固定周围再骨折现象纳为研究组，其余75例患者归为对照组。分析老年患者经股骨粗隆间骨折PFNA术后内固定周围再骨折的相关影响因素。

结果 研究组中年龄>75岁、未进行术后功能锻炼、主钉因素、骨质疏松分级为4～6级（严重）、未进行抗骨质疏松治疗所占比例显著高于对照组（P<0.05）。年龄（r=0.239，P=0.009），未进行术后功能锻炼（r=0.246，P=0.007），主钉因素（r=0.217，P=0.017），骨质疏松分级（r=0.355，P<0.001），未进行抗骨质疏松治疗（r=0.226，P=0.013）与再骨折呈正相关。经多因素分析，年龄>75岁（OR=2.737，95%CI=1.278～5.836）、未进行术后功能锻炼（OR=3.187，95%CI=1.345～7.553）和抗骨质疏松治疗（OR=2.630，95%CI=1.210～5.720）、主钉因素（OR=2.667，95%CI=1.172～6.067）、骨質疏松分级为4～6级（严重）（OR=4.669，95%CI=2.054～10.404）是导致老年股骨粗隆间骨折PFNA术后内固定周围再骨折的独立危险因素（P<0.05）。

结论 老年股骨粗隆间骨折患者实施PFNA术后发生内固定周围再骨折危险因素较多，临床应给予相应的干预措施预防内固定周围再骨折的发生。

【关键词】 老年;股骨粗隆间骨折;PFNA术;内固定;再骨折

中图分类号：R687.3    文献标志码：A   DOI：10.3969/j.issn.1003-1383.2021.09.003

Analysis of related influencing factors of re-fracture around internal fixation after PFNA in elderly patients with intertrochanteric fracture of femur

LIU Shaozhenga， LI Yuejunb， LI Xuedongc

（a.Department of Orthopedics， b. The First Department of Orthopedics， c.The Second Department of Orthopedics， Zhengzhou Orthopedic Hospital， Zhengzhou 450052，  Henan， China）

【Abstract】 Objective To analyze the related factors of re-fracture around internal fixation after proximal femoral nail antirotation （PFNA） internal fixation in the elderly.

Methods A total of 120 elderly patients with intertrochanteric fractures of femur who were admitted to our hospital from January 2019 to February 2020 were selected as research objects. All patients underwent PFNA surgery for femoral intertrochanteric fractures. After operation， 45 patients with re-fracture around internal fixation were included in study group， and the remaining 75 patients were included in control group. And then， the related influencing factors of re-fracture around the internal fixation after PFNA in elderly patients with intertrochanteric fracture of femur were analyzed.

Results In the study group， the proportion of age > 75 years old， no postoperative functional exercise， main nail factor， osteoporosis grade was 4-6 （severe）， and no anti-osteoporosis treatment was significantly higher than that of the control group （P < 0.05）. Age （r = 0.239， P = 0.009）， no postoperative functional exercise （r = 0.246， P = 0.007）， main nail factor （r = 0.217， P = 0.017）， osteoporosis grade （r=0.355， P <0.001） and no anti-osteoporosis treatment （r = 0.226， P = 0.013） were positively correlated with re-fracture. Multivariate analysis showed that age > 75 years old （OR = 2.737， 95%CI = 1.278-5.836）， no postoperative functional exercise （OR = 3.187， 95%CI = 1.345-7.553） and anti-osteoporosis treatment （OR = 2.630， 95%CI = 1.210-5.720）， main nail factor （OR = 2.667， 95%CI = 1.172-6.067）， osteoporosis grade 4-6 （severe） （OR = 4.669， 95%CI = 2.054-10.404） were independent risk factors for re-fractures around internal fixation after PFNA among elderly patients with intertrochanteric fractures of femur （P < 0.05）.

Conclusion Elderly patients with femoral intertrochanteric fractures of femur have more risk factors for re-fractures around internal fixation after PFNA， so correspondingly clinical interventions should be given to prevent re-fractures around internal fixation.

【Key words】  the elderly; intertrochanteric fracture of femur; PFNA; re-fracture

股骨粗隆间骨折属于临床常见骨折类型，高发于老年群体，股骨近端抗旋转髓内钉（proximal femoral nail anti-rotation，PFNA）内固定是治疗该骨折类型最常见方式，效果理想[1～3]。但受多种因素影响，患者术后有较大概率会出现内固定周围再骨折，不但增加了患者的治疗痛苦，还会提升二次手术的难度与风险，患者预后较差[4～5]。因此，临床极为重视患者再骨折因素。笔者对在我院行股骨粗隆间骨折PFNA术的老年患者进行分析，找出与内固定周围再骨折的相关因素，以期改善老年股骨粗隆间骨折患者预后。