摘要目的 探讨闭合复位髓内、外内固定治疗老年股骨转子间骨折术后内固定失败的影响因素. 方法 回顾性分析2005年9月至2014年8月采用闭合复位动力髋螺钉(DHS)、股骨近端防旋髓内钉(PFNA)固定治疗的205例老年骨质疏松性股骨转子间骨折患者资料,男89例,女116例;年龄为65 ～ 98岁,平均78.8岁;骨折AO分型:稳定型(A1.1型至A2.1型)137例,不稳定型(A2.2型至A3.3型)68例.记录患者内固定失败的发生率及末次随访时髋关节Harris评分.对内固定失败的可能影响因素进行单因素分析,并拟合多因素logistic回归模型.结果 192例患者术后获平均39个月(14～60个月)随访,13例患者随访10个月后失访.在205例患者中,12例患者出现内固定失败,发生率为5.9％;其中DHS固定5例,PFNA固定7例.末次随访时(13例失访患者术后10个月时)髋关节Harris评分平均为81.6分(57 ～ 92分);优29例,良145例,可10例,差21例,优良率为84.9％.多因素logistic回归分析结果显示:尖顶距＞ 25 mm(OR=333.33)、重度骨质疏松(OR=267.44)、AO分型为不稳定型骨折(OR=22.24)、骨折功能复位(OR=20.79)、合并内科疾病(OR=4.59)是内固定失败的独立危险因素(P＜0.05). 结论 DHS与PFNA均是治疗股骨转子间骨折的有效治疗方法.尖顶距＞25 mm、重度骨质疏松、不稳定型骨折、功能复位及合并内科疾病均可能导致老年股骨转子间骨折的内固定失败.

abstractsObjective To analyze the risk factors for failures of intramedullary and extramedullary internal fixation in surgery of femoral intertrochanteric fractures in elderly patients.Methods A retrospective study was conducted of the 205 elderly patients with osteoporotic femoral intertrochanteric fracture who had accepted closed reduction together with intramedullary and extramedullary internal fixation between September 2005 and August 2014.They were 89 men and 116 women,from 65 to 98 year of age (average,78.8 years).By AO classification,137 cases were of types AI.1-A2.1 (stable fractures),and 68 of type A2.2-A3.3(unstable fractures).The incidence of internal fixation failure and Harris scores at the last follow-up were recorded.The factors possibly contributing to the failure were analyzed using the univariate analysis and multivariate logistic regression analysis.Results Of the patients,192 obtained a mean follow-up of 39 months (from 14 to 60 months),but 13 were lost after a 10-month follow-up.Of the 205 patients,internal fixation failure occurred in 12 (incidence of 5.9％).Five failed cases received DHS fixation and 7 accepted PENA fixation.At the last follow-up when the 13 cases were lost after 10-month follow-up,the mean Harris hip score was 81.6 (from 57 to 92),and the excellent to good rate was 84.9％ (29 excellent cases,145 good ones,10 fair ones and 21 poor ones).The multivariate regression analysis revealed that tip-apex distance (TAD) ＞ 25 mm(OR ＝ 333.33),severe osteoporosis (OR =267.44),AO types A2.2-A3.3 (OR ＝ 22.24),functional reduction of fracture (OR =20.79),and concomitant medical diseases (OR =4.59) were independent risk factors for failures of internal fixation.Conclusions DHS and PFNA fixations are effective treatments for elderly patients with femoral intertrochanteric fractures.TAD＞ 25 mm,severe osteoporosis,unstable factures,functional reduction of fracture,and concomitant medical diseases may lead to internal fixation failure in surgery of femoral intertrochanteric fractures in elderly patients.