中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (33): 7189-7195.doi: 10.12307/2025.838

• 骨科植入物 orthopedic implant • 上一篇    下一篇

股骨转子间骨折股骨近端防旋髓内钉置入后髋关节功能恢复及预测模型构建

严金涟1,2,许争权1,2,魏仁杰1,2,王业华2   

  1. 1徐州医科大学,江苏省徐州市   221000;2徐州医科大学附属医院骨科,江苏省徐州市   221000
  • 收稿日期:2024-07-08 接受日期:2024-09-05 出版日期:2025-11-28 发布日期:2025-04-12
  • 通讯作者: 王业华,博士,主任医师,徐州医科大学附属医院骨科,江苏省徐州市 221000
  • 作者简介:严金涟,男,1992年生,江苏省淮安市人,汉族,徐州医科大学在读硕士,医师,主要从事骨外科学研究。

Hip joint function recovery and prediction model construction after proximal femoral nail antirotation for intertrochanteric fractures

Yan Jinlian1, 2, Xu Zhengquan1, 2, Wei Renjie1, 2, Wang Yehua2   

  1. 1Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China; 2Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
  • Received:2024-07-08 Accepted:2024-09-05 Online:2025-11-28 Published:2025-04-12
  • Contact: Wang Yehua, PhD, Chief physician, Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
  • About author:Yan Jinlian, Master candidate, Physician, Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China; Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China

摘要:


文题释义:

股骨转子间骨折:发生于股骨大转子与小转子之间的骨折,好发于中老年骨质疏松患者,是髋部常见的骨折类型,多由间接外力引起,如跌倒时身体发生旋转、强力内收或外展,伤后表现为局部疼痛、肿胀及功能障碍,长期卧床并发症多。
股骨近端防旋髓内钉:是一种新型的股骨近端髓内钉系统,主要由主钉、螺旋刀片、锁钉3部分构成,与股骨近端髓内钉生物力学特点相同,同时在设计上更加创新,能够使骨折固定更有效、更简单,适用于各种类型的转子间骨折。


背景:目前国内外研究主要集中在不同术式治疗股骨转子间骨折的比较及股骨近端防旋髓内钉手术失败的风险,对股骨近端防旋髓内钉术后患肢髋关节功能预后研究较少。

目的:分析老年转子间骨折患者行股骨近端防旋髓内钉置入后髋关节功能恢复不良的影响因素,构建术后髋关节功能预测评分系统并探讨其价值。
方法:选择2021年6月至2023年6月在徐州医科大学附属医院接受股骨近端防旋髓内钉内固定治疗的股骨转子间骨折患者150例,根据术后随访Harris髋关节功能评分分组,评分≥80分为优良组,评分< 80分为不良组,采用单因素及二元回归分析探讨导致术后髋关节功能不良的危险因素,根据危险因素建立评分表。采用受试者工作曲线探讨该评分系统预测股骨近端防旋髓内钉置入术后髋关节功能的价值。 

结果与结论:①150例患者根据术后1年随访时患侧髋关节Harris评分标准分组,功能恢复不良组52例,恢复优良组98例,不良率为34.7%;②两组患者单因素比较结果显示:术后髋关节功能不良组与优良组在年龄、骨密度、术前基础合并症数量、外侧壁的分型、螺旋刀片位置、复位质量及术后初次下床锻炼时间方面存在显著差异(P < 0.05);③二元Logistic回归分析结果显示:年龄≥75岁(OR=2.834)、骨质疏松(OR=3.002)、术前基础合并症数量> 2个(OR=4.024)、外侧壁破裂(OR=2.999)、螺旋刀片位置差(OR=4.025)、术后初次下床锻炼时间> 4周(OR=3.153)是转子间骨折行股骨近端防旋髓内钉置入术后髋关节功能不良的独立危险因素(P < 0.05),复位质量差(OR=1.026)是非独立危险因素(P > 0.05);④依据二元回归分析结果构建术后髋关节功能优良预测评分系统,经受试者工作特征曲线分析,此评分系统预测术后髋关节功能不良的界值为4.5分,曲线下面积为0.797,灵敏度为83.7%,特异性为65.4%;⑤提示年龄≥75岁、骨质疏松、术前基础合并症数量> 2个、外侧壁破裂、螺旋刀片位置差、术后初次下床锻炼时间> 4周是转子间骨折行股骨近端防旋髓内钉术后发生髋关节功能不良的危险因素,构建评分预测系统可以为临床早期识别术后髋关节功能不良的高风险患者提供参考价值,有利于指导临床早期干预、采用更加个性化的治疗及康复方案,促进患者术后髋关节功能恢复。

https://orcid.org/0009-0007-4169-6111 (严金涟) 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 股骨转子间骨折, 股骨近端抗旋髓内钉, 随访, 髋关节功能, 骨质疏松, 危险因素, 骨科植入物

Abstract: BACKGROUND: At present, domestic and foreign studies mainly focus on the comparison of different operation methods for intertrochanteric fracture of femur and the risk of failure in proximal femoral nail antirotation operation. There are few studies on the prognosis of hip function of affected limb after proximal femoral nail antirotation.   
OBJECTIVE: To analyze the influencing factors of poor hip function recovery in elderly patients with intertrochanteric fracture after proximal femoral nail antirotation surgery, and to construct a score system for predicting hip function after surgery and explore its value. 
METHODS: A total of 150 patients with intertrochanteric fracture of femur who received proximal femoral nail antirotation surgery in the Affiliated Hospital of Xuzhou Medical University from June 2021 to June 2023 were selected and divided into groups according to the Harris hip function score during postoperative follow-up. A score ≥80 was considered as the good group, and a score < 80 was considered as the poor group. Univariate and binary regression analyses were used to explore the risk factors leading to postoperative hip dysfunction. A score scale was established according to the risk factors. The value of this scoring system in predicting hip function after proximal femoral nail antirotation was investigated by using receiver operating characteristic curve. 
RESULTS AND CONCLUSION: (1) Among the 150 patients, according to the Harris score standard of the affected hip joint at 1 year follow-up, there were 52 cases in the group with poor functional recovery and 98 cases in the group with excellent functional recovery, with an unsatisfactory rate of 34.7%. (2) The results of univariate comparison between the two groups showed that there were significant differences in age, bone mineral density, number of preoperative underlying complications, type of lateral wall, position of spiral blade, quality of reduction and time of first exercise after surgery between the poor group and the good group (P < 0.05). (3) The results of binary Logistic regression analysis showed: Age ≥75 years old (OR=2.834), osteoporosis (OR=3.002), number of preoperative basic complications > 2 (OR=4.024), lateral wall rupture (OR=2.999), position difference of spiral blade (OR=4.025), and time to exercise for the first time after surgery > 4 weeks (OR=3.153) were independent risk factors for hip dysfunction after proximal femoral nail antirotation for the intertrochanteric fractures (P < 0.05); poor reduction quality (OR=1.026) was not an independent risk factor (P > 0.05). (4) Based on the results of binary regression analysis, a score system for predicting good hip function after surgery was established. Receiver operating characteristic curve analysis showed that the threshold for predicting poor hip function after surgery was 4.5 points; the area under the curve was 0.797; the sensitivity was 83.7% and the specificity was 65.4%. (5) These results suggested that age ≥75 years old, osteoporosis, number of preoperative basic comorbidities > 2, lateral wall rupture, poor position of spiral blade, and first time out of bed exercise > 4 weeks after intertrochanteric fracture were risk factors for hip dysfunction after proximal femoral nail antirotation. The establishment of a score prediction system can provide reference value for early clinical identification of high-risk patients with postoperative hip dysfunction, and is conducive to guiding early clinical intervention, adopting more personalized treatment and rehabilitation programs, and promoting the recovery of hip function in patients after surgery.

Key words: intertrochanteric fracture, proximal femoral nail antirotation, follow-up, hip function, osteoporosis, risk factor, orthopedic implant

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