摘要
目的 探讨分析股骨转子间骨折内固定术后骨折愈合不良的相关危险因素.方法 选取 2018 年 6月至 2021 年 6 月南阳医学高等专科学校第二附属医院收治的 674 例股骨转子间骨折患者作为研究对象,收集患者性别、年龄、体重指数、骨折类型、骨折粉碎程度、螺钉位置、术后负重时间、术后感染情况、是否合并糖尿病、是否合并骨质疏松等资料,并根据股骨转子间骨折内固定术后 3 个月骨折愈合情况将其分为愈合组和愈合不良组,多因素Logistic回归分析股骨转子间骨折内固定术后骨折愈合不良的危险因素.结果 股骨转子间骨折内固定术后 3 个月,674 例患者中出现骨折愈合不良 66 例(9.79%),设为愈合不良组;骨折愈合良好 608 例(90.21%),设为愈合组.单因素分析结果显示,愈合不良组年龄≥60 岁、不稳定型骨折、骨折粉碎程度高、螺钉位置不理想、术后负重过迟、术后感染以及合并有糖尿病、骨质疏松的患者比例均明显高于愈合组(χ2= 6.347、9.520、9.985、40.089、4.176、17.623、4.250、7.125,P=0.012、P=0.002、P=0.002、P＜0.001、P= 0.041、P＜0.001、P=0.039、P=0.008);多因素Logistic回归分析结果显示,不稳定型骨折、骨折粉碎程度高、螺钉位置不理想、术后负重过迟、术后感染、合并骨质疏松是股骨转子间骨折内固定术后骨折愈合不良的独立危险因素(95%CI 为 3.831～15.407、3.588～13.551、3.516～12.868、3.387～12.206、5.594～28.683、4.799～21.792,P均＜0.001).结论 股骨转子间骨折内固定术后骨折愈合不良与骨折类型、骨折粉碎程度、螺钉位置、术后负重时间、术后感染情况、是否合并骨质疏松有关.
Abstract
Objective To analyze the risk factors for poor fracture healing following internal fixation for femoral intertrochanteric fractures.Methods 674 patients with femoral intertrochanteric fractures,admitted to The Second Affilia-ted Hospital of Nanyang Medical College between June 2018 and June 2021 were selected as research subjects,and their data were collected,including sex,age,body mass index,fracture type,degree of fracture comminution,screw position,postoperative weight-bearing time,postoperative infection,with diabetes and osteoporosis or not,etc.The patients were divided,according to the fracture healing condition three months after the internal fixation for femoral intertrochanteric fractures,into healed group and poor healing group.Multivariate Logistic regression analysis was conducted to analyze the risk factors for poor fracture healing following the internal fixation for femoral intertrochanteric fractures.Results Three months after the internal fixation for femoral intertrochanteric fractures,of the 674 patients,66 cases(9.79%)who suffered poor fracture healing were set as the poor healing group,while the other 608 cases(90.21%)who achieved well fracture healing were set as the healed group.Univariate analysis showed that the proportions of patients with age≥60 years,unsta-ble fracture,high degree of fracture comminution,unsatisfactory screw position,late postoperative weight-bearing time,postoperative infection,and complicated with diabetes and osteoporosis in the poor healing group were significantly higher than those in the healed group(χ2=6.347,9.520,9.985,40.089,4.176,17.623,4.250 and 7.125,P=0.012,P= 0.002,P=0.002,P＜0.001,P= 0.041,P＜0.001,P= 0.039,P= 0.008).Multivariate Logistic regression analysis found that unstable fracture,high degree of fracture comminution,unsatisfactory screw position,late postoperative weight-bearing time,postoperative infection,and complicated with osteoporosis were the independent risk factors of poor fracture healing following internal fixation for femoral intertrochanteric fractures(95%CI:3.831-15.407,3.588-13.551,3.516-12.868,3.387-12.206,5.594-28.683 and 4.799-21.792,all P＜0.001).Conclusion Poor fracture healing following the internal fixation for femoral intertrochanteric fractures is associated with fracture type,degree of fracture comminution,screw position,postoperative weight-bearing time,postoperative infection,and osteoporosis as a comorbidity.
维普
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