股骨近端交锁髓内钉治疗股骨转子间骨折术后医源性外侧壁骨折的影响因素分析

doi:10.3760/cma.j.cn101202-20230714-00177

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摘要目的探讨股骨转子间骨折患者经股骨近端交锁髓内钉治疗后发生医源性外侧壁骨折的影响因素。方法回顾性队列研究。纳入郑州市骨科医院2020年12月—2022年12月经股骨近端交锁髓内钉治疗的278例股骨转子间骨折患者的临床资料,其中男142例、女136例,年龄56~85（70.6±7.1）岁。术后第2天经X线或CT检查患者治疗后医源性外侧壁骨折的发生情况,采用单因素及多因素logistic回归分析其发生的影响因素。结果 278例患者中45例术后出现医源性外侧壁骨折,发生率为16.19%。有、无外侧壁骨折的患者间比较,年龄、骨折分型及股骨外侧壁厚度差异均有统计学意义（P值均<0.05）,而性别、体质量指数、合并内科疾病、尖顶距、骨密度、受伤至手术时间、受伤原因、手术时间、术中出血量及术后卧床时间等因素比较,差异均无统计学意义（P值均>0.05）;将单因素分析中差异有统计学意义的指标纳入多因素logistic回归分析,结果显示骨折分型A2.2~A3.3型（比值比1.316,95%可信区间1.016~1.705）、股骨外侧壁厚度（比值比0.546,95%可信区间0.446~0.668）为股骨转子间骨折患者术后医源性外侧壁骨折发生的独立危险因素（P值均<0.05）。结论骨折分型、股骨外侧壁厚度均是股骨转子间骨折患者经股骨近端交锁髓内钉术后发生医源性外侧壁骨折的独立危险因素;患者的骨折分型等级较高、股骨外侧壁较薄,发生医源性外侧壁骨折的可能性相对较高。

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	张金星
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关键词 ：髋骨折, 医源性外侧壁骨折, 股骨转子间骨折, 骨折固定术, 内, 股骨近端交锁髓内钉, 影响因素

Abstract：Objective This study aimed to analyze the influencing factors on medically induced lateral wall fractures in patients with intertrochanteric femur fractures treated with interlocking intramedullary nailing of the proximal femur. Methods A retrospective cohort study was conducted. The clinical data of 278 patients with intertrochanteric femur fractures treated by interlocking intramedullary nailing of the proximal femur in Zhengzhou Orthopedic Hospital from December 2020 to December 2022 were included. The patients included 142 males and 136 females, aged 56-85 (70.6±7.1) years. The incidence of medically induced lateral wall fractures in patients after treatment was counted, and the factors affecting their occurrence were analyzed by univariate and multivariate logistic regressions. Results Forty-five out of the 278 patients developed postoperative medically induced lateral wall fractures, with an incidence rate of 16.19%. Comparison between patients with and without posterolateral wall fractures showed that the differences in age, fracture type A2.2-A3.3, and posterolateral femoral wall thickness were statistically significant (all P values <0.05). Meanwhile, the differences in comparison of gender, body mass index, comorbid medical disorders, tarsal apical distance, bone mineral density, time from injury to surgery, cause of injury, operative time, bleeding, and postoperative bed rest time were not statistically significant (all P values > 0.05). The items with statistically significant differences in the univariate analysis were included in the multifactorial logistic regression analysis, and the results showed that fracture type A2.2-A3.3 (odds ratio 1.316, 95% confidence interval 1.016-1.705) and lateral femoral wall thickness (odds ratio 0.546, 95% confidence interval 0.446-0.668) were independent risk factors influencing the occurrence of medically induced lateral wall fracture in patients with intertrochanteric fracture of the femur after treatment (all P values < 0.05). Conclusion Fracture classification and thickness of the external wall of the femur are independent risk factors affecting iatrogenic external wall fractures in patients with intertrochanteric fractures after proximal femoral interlocking intramedullary nail treatment. The higher the grade of fracture classification and the thinner the thickness of the external wall of the femur, the greater the possibility of iatrogenic external wall fracture.

Key words： Hip fractures Iatrogenic lateral wall fracture Intertrochanteric fracture of the femur Fracture fixation internal Proximal femur interlocking intramedullary nail Influencing factors

收稿日期: 2023-07-14

基金资助:河南省医学科技攻关计划（LHGJ20200691）

通讯作者: 张金星, Email:zjx200671@163.com

引用本文:

张金星, 海啸, 于鸿, 杜丽萍. 股骨近端交锁髓内钉治疗股骨转子间骨折术后医源性外侧壁骨折的影响因素分析[J]. 中华解剖与临床杂志, 2024, 29(2): 111-115.
Zhang Jinxing, Hai Xiao, Yu Hong, Du Liping. Analysis of the influencing factors on iatrogenic external wall fracture in patients with intertrochanteric fracture treated by proximal interlocking intramedullary nailment. Chinese Journal of Anatomy and Clinics, 2024, 29(2): 111-115.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20230714-00177 或 http://www.cjac.com.cn/CN/Y2024/V29/I2/111

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