目的 探讨老年股骨粗隆间骨折患者股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)术后髋关节功能的影响因素.方法 选择2020年1月至2023年1月山东省文登整骨医院行PFNA术的老年股骨粗隆间骨折患者176例,根据术后6个月随访时Harris髋关节评分情况分为髋关节功能恢复良好组和不良组.采用多因素logistic回归方程分析影响老年患者PFNA术后髋关节功能的因素.结果 176例患者中男96例、女80例;年龄66～85岁,平均(75.8±4.1)岁.176例患者术后Harris评分为(92.3±3.7)分.PFNA术后6个月,髋关节功能恢复良好124例(70.5%).多因素logistic回归分析结果显示,术前骨密度<-2.5 SD(OR=3.117,95%CI:1.260～7.710,P=0.014)和术后开始负重时间>7.7 d(OR=2.519,95%CI:1.061～5.980,P=0.037)的老年股骨粗隆间骨折患者术后髋关节功能恢复较差.结论 老年股骨粗隆间骨折患者术前骨密度降低和术后负重时间延长是影响术后功能恢复的危险因素.建议加强老年患者术前骨密度筛查力度、改善骨质疏松程度,并重视术后早期的负重锻炼和指导.
Analysis of influencing factors of postoperative hip function in elderly patients with femoral intertrochanteric fracture
Objective To explore the influencing factors of hip joint function after proximal femoral nail antirotation(PFNA)in elderly patients with femoral intertrochanteric fracture.Methods A total of 176 elderly patients with femoral intertrochanteric fracture undergoing PFNA in Shandong Wendeng Osteopathic Hospital were selected from January 2020 to January 2023.According to Harris hip scores at six months after follow-up of surgery,the patients were divided into good hip function recovery group and poor hip function recovery group.Multivariate logistic regression equation was used to analyze the factors influencing hip joint function after PFNA in the elderly patients.Results Among the 176 patients,there were 96 males and 80 females,the age ranged from 66 to 85 years,with an average age of(75.8±4.1)years.Harris score of the 176 patients after surgery was(92.3±3.7)score.Six months after PFNA,there were 124 cases(70.5%)recovered well in hip joint function.Multivariate logistic regression analysis results showed that patients with preoperative bone mineral density<-2.5 SD(OR=3.117,95%CI:1.260-7.710,P=0.014)and the time of weight loading after operation>7.7 d(OR=2.519,95%CI:1.061-5.980,P=0.037)were more likely to poor postoperative hip function recovery.Conclusions The decrease of preoperative bone mineral density and the extension of postoperative load-bearing time in elderly patients with femoral intertrochanteric fracture are risk factors influencing postoperative hip function recovery.It is suggested to strengthen the preoperative bone mineral density screening and improve osteoporosis,and also pay attention to early load-bearing exercise and guidance after surgery in the elderly patients.
femoral intertrochanteric fracturebone mineral densityload-bearing timeproximal femoral nail antirotation(PFNA)hip functionelderly
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