防旋股骨近端髓内钉治疗老年股骨粗隆间骨折的术后康复效果及影响因素分析

Analysis of postoperative rehabilitation effects and its influencing factors of PFNA in treatment of femoral intertrochanteric fractures in the elderly

中文关键词: 老年  股骨粗隆间骨折  防旋股骨近端髓内钉  影响因素  术后功能康复

英文关键词: elderly  femoral intertrochanteric fracture  proximal femoral nail antirotation  influencing factor  postopera-tive functional rehabilitation

中文摘要:

      目的 探析防旋股骨近端髓内钉(PFNA)治疗老年股骨粗隆间骨折的术后康复效果及影响因素.方法 回顾性选取2022年2月—2024年2月在广安市人民医院就诊的207例老年股骨粗隆间骨折患者的临床资料,根据术后6个月的髋关节Harris对功能康复情况的评分,分为术后功能康复不良组(n=36)和术后功能康复良好组(n=171).采用Logistic回归方法分析影响术后功能康复的相关因素.结果 与术后功能康复良好组比较,术后功能康复不良组患者年龄76～85岁、手术时机＞3d、骨折分型A3型、血红蛋白异常、白蛋白异常、术中出血量≥20 mL、术中和术后出现并发症、内固定稳定性一般的占比更高,术后1周Harris评分更低,差异均有统计学意义(P＜0.05).Logistic回归分析结果显示,手术时机＞3 d、年龄76～85岁、手术质量、术后康复质量为老年股骨粗隆间骨折患者PFNA术后功能康复不良的独立危险因素(P＜0.05).结论 手术时机＞3d、年龄76～85岁、手术质量、术后康复质量可能是老年股骨粗隆间骨折PFNA术后功能康复不良的独立危险因素,应针对高风险患者优化围术期管理,以改善术后功能康复效果.

英文摘要:

      Objective To explore the postoperative rehabilitation effects and its influencing factors of proximal femoral nail antirotation(PFNA)in the treatment of femoral intertrochanteric fractures in the elderly.Methods The clinical data of 207 elderly patients with femoral intertrochanteric fractures treated in People's Hospital of Guang'an City from February 2022 to February 2024 were retrospectively selected.According to the Harris score of the hip joint functional rehabilitation at 6 months after the operation,the patients were divided into poor postoperative functional rehabilitation group(n=36)and good postop-erative functional rehabilitation group(n=171).Logistic regression method was used to analyze the related factors influencing postoperative functional rehabilitation.Results Compared with the good postoperative functional rehabilitation group,the poor postoperative functional rehabilitation group had a higher proportion of patients aged 76-85 years,surgery timing＞3 days,frac-ture type A3,abnormal hemoglobin,abnormal albumin,intraoperative blood loss≥20 mL,intraoperative and postoperative complications,and general internal fixation stability,and a lower Harris score at 1 week after surgery.The differences were sta-tistically significant(P＜0.05).The results of logistic regression analysis showed that the surgical timing＞3 days,age 76-85 years old,surgical quality,and postoperative rehabilitation quality were independent risk factors for poor functional recovery af-ter PFNA surgery in elderly patients with femoral intertrochanteric fractures(P＜0.05).Conclusion Surgical timing＞3 days,age 76-85 years old,surgical quality,and postoperative rehabilitation quality are independent risk factors for poor func-tional rehabilitation after PFNA in elderly patients with femoral intertrochanteric fractures.Perioperative management should be optimized for high-risk patients to improve the postoperative functional rehabilitation effect.