老年股骨转子间骨折PFNA术后复位丢失的原因分析

发布时间：2018-01-16 17:16

本文关键词：老年股骨转子间骨折PFNA术后复位丢失的原因分析　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：探讨老年股骨转子间骨折PFNA术后复位丢失的危险因素,预测术后出现复位丢失的可能,指导进一步的功能锻炼,降低出现内固定术后复位丢失的风险。方法：回顾性分析自2010年1月至2014年12月收治的86例老年股骨转子间骨折患者的临床资料,男37例,女49例；年龄60-94岁。以Baumgaertner复位质量评价术后1周与术后12周前后两次对比结果为判断复位丢失等级的标准。其中复位丢失组27例(31.4%),非复位丢失组59例(68.6%)。收集患者的基本信息、骨折类型、Singh指数、术前ASA评级、术后1周TAD、术后1周的复位质量、术后12周的复位质量、复位后股骨内侧小转子骨块移位等。采用Logistic回归分析确定股骨转子间骨折PFNA术后复位丢失的危险因素。统计前后位及侧位X光片螺旋刀片位置分布情况并分析其与复位丢失的关系。结果：复位丢失组与非复位丢失组比较临床基线数据比较发现,骨折类型x 2=9.276,P=0.0260.05,说明两组之间骨折各类型占有率之间差异有统计学意义；术后1周TAD指标t=-4.354,P=0.0000.01,说明两组之间术后1周TAD差异有统计学意义；术后一周复位质量x 2=11.216,P=0.0010.01,说明两组之间术后一周复位质量人数比例差异有统计学意义；正位片中心位置钉区域x2=19.392,P=0.0000.01,说明两组组间的头颈钉在股骨头内位置的比例差异有统计学意义；其余各指标P值均大于0.05,说明差异无统计学意义。Logistic单因素分析报告,骨折类型、术后一周TAD、术后1周复位质量、正位片中心位置钉区域四个指标的P值小于0.05,说明四个指标与复位丢失之间的相关性具有统计学意义；性别、年龄、后股骨内侧小转子骨块移位、Singh指数、术前ASA评分5个指标的P值均大于0.05,说明五个指标与复位丢失之间的相关性没有统计学意义。Logistic多因素回归分析报告,术后1周TAD、术后1周复位质量、正位片中心位置钉区域对复位丢失的影响具有统计学意义(P0.05),术后1周TAD的OR=0.218,说明TAD25mm更容易引起复位丢失,是TAD25mm引起复位丢失的4.6倍；术后1周复位质量的OR=5.508,复位质量为优时是复位丢失的保护因素,说明复位质量为“可差”时导致复位丢失的危险是复位质量为“优”时的5.5倍。正位片中心位置钉区域的OR=10.393,P=0.0000.01,具有统计学意义,表示正位片偏心位置置钉,即1号、4号区域是复位丢失的保护因素,在中心位区域置钉导致复位丢失的危险是偏心位置钉的10.4倍；骨折类型指标的P值大于0.05,我们认为在多因素分析中,对复位丢失的影响没有统计学意义。结论：术中复位质量根据Baumgaertner标准至少等级为良以上,股骨后内侧皮质骨块移位在5mm内的可以不强求解剖复位,螺旋刀片尖顶距TAD值在25m以内,合理置钉区域在BC区,螺旋刀片尖端位于1号和4号区域。对于不稳定型骨折(Ic、Id型)以及严重骨质疏松患者,手术医生更应该严格要求以保证手术质量,术后积极防治骨质疏松,以降低发生术后复位丢失的风险系数。
[Abstract]:Objective: To investigate the risk of fracture after PFNA loss of reduction factors of senile intertrochanteric, loss of reduction may be predictive of postoperative functional exercise guidance, further, to reduce the risk of internal fixation after loss of reduction appeared. Methods: a retrospective analysis of the clinical data of 86 cases of femur in the elderly from January 2010 to December 2014 were patients with intertrochanteric fracture the male 37 cases, female 49 cases; age 60-94. Baumgaertner to reset quality evaluation after 1 weeks and 12 weeks after surgery before and after the two results to determine the loss of reduction rating standards. The loss of reduction group and 27 cases (31.4%), 59 cases of non loss reduction group (68.6%). The basic information. Collect the patients with fracture type, Singh index, preoperative ASA rating, TAD after 1 weeks of operation, the quality of reduction and 1 weeks after operation, the quality of reduction after 12 weeks, after the restoration of the medial femoral lesser trochanter bone displacement. Logistic regression analysis was used to determine the Risk of fracture after PFNA loss of reduction factor of femoral intertrochanteric. Statistical anteroposterior and lateral radiographs of X spiral blade position distribution and analysis of its relationship with the loss of reduction. Results: the loss of reduction and non reduction loss comparison group baseline clinical data, fracture type X 2=9.276, P=0.0260.05, that between the two groups each type of fracture was statistically significant difference between the share; t=-4.354, 1 weeks after operation P=0.0000.01 TAD index shows that, between the two groups was statistically significant difference after 1 weeks TAD; one week after operation, X 2=11.216 P=0.0010.01, the quality of reduction, said there were statistically significant differences in the quality of reduction ratio of the number of a week after surgery between the two groups; a center of nail area x2=19.392, P=0.0000.01, two groups of head and neck nail was statistically significant in the femoral head position ratio difference; the rest of the index P values are greater than 0.05, said The difference was not statistically significant.Logistic single factor analysis, fracture type, one week after operation TAD, after 1 weeks, the quality of reduction, a center of regional nail four indicators P value is less than 0.05, indicating statistically significant correlation between the four indexes and the loss of reduction; gender, age, after the medial femur the lesser trochanter bone displacement, Singh index, preoperative ASA score of 5 indicators of the P values are greater than 0.05, indicating the correlation between the five indexes and the loss of reduction is no statistically significant factor.Logistic regression analysis, TAD 1 weeks after operation, 1 weeks after operation, the quality of reduction, a center area has a nail significant impact on the loss of reduction (P0.05), OR=0.218 TAD 1 weeks after operation, TAD25mm is more likely to cause the loss of reduction, is caused by TAD25mm 4.6 times the loss of reduction; OR=5.508 1 weeks postoperative reduction quality, excellent quality is reset Protective factors of loss of reduction, illustrate the reduction quality as "poor" when the risk of loss of reduction is the reduction quality as "5.5 times". When a nail center region of OR=10.393, P=0.0000.01, have statistical significance, that is a piece of eccentric screw position, namely No. 1, No. 4 area is a protective factor for loss of reduction, resulting in loss of reduction of the risk of the nail is 10.4 times the eccentric position in the center of the area of nail; fracture type index P value is greater than 0.05, we believe that in multivariate analysis, no statistically significant effect on the loss of reduction. Conclusion: the quality of reduction was based on the Baumgaertner standard at least grade for the good, the posterior femoral medial cortical bone displacement within the 5mm can not force anatomical reduction, spiral blade tip apex distance TAD value within 25m, reasonable placement area in the BC District, located in the tip of spiral blade No. 1 and No. 4 area. For unstable fractures (Ic, Id) and severe osteoporosis, surgeons should be more strict in order to ensure the quality of surgery, and prevent osteoporosis after operation, so as to reduce the risk factor of postoperative reduction loss.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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