中国骨伤2025，Vol.38Issue(2)：141-147,7.DOI:10.12200/j.issn.1003-0034.20240891
髓内钉固定治疗老年股骨转子间骨折髋螺钉切出的危险因素分析
Risk factors for cutout failure in geriatric intertrochanteric fracture patients after cephalomedullary nail fixation
摘要
Abstract
Objective To determine risk factors for cutout failure in geriatric intertrochanteric fracture patients after cephalomedullary nail fixation.Methods A retrospective review of 518 elderly patients who underwent cephalomedullary nail fixation for intertrochanteric fractures between January 2008 and August 2018 was conducted,including 167 males and 351 fe-males,age from 65 to 97 years old.All patients were followed up for at least one year after surgery and divided into a healed group and a cutout group based on whether the hip screw cutout occurred.Among all patients,10 cases experienced hip screw cutout.The general information,surgical data,and radiological data of the two groups were compared,and risk factors influenc-ing hip screw cutout were analyzed.Propensity score matching was then performed on the cutout group based on gender,age,body mass index(BMI),and American Society of Anesthesiologists(ASA),and 40 patients from the healed group were matched at a ratio of 1∶4.Key risk factors affecting hip screw cutout were further analyzed.Multivariable logistic regression analysis was conducted to evaluate associations between variables and cutout failure.Results There were no statistically signif-icant differences between the healed group and the cutout group in terms of age,gender,BMI,ASA,and AO classification.However,statistically significant differences were observed between the two groups in terms of reduction quality(P=0.003)and tip-apex distance(TAD),P＜0.001.Multivariate analysis identified poor reduction quality OR=23.138,95％CI(2.163,247.551),P=0.009 and TAD ≥25 mm OR=30.538,95％CI(2.935,317.770),P=0.004 as independent risk factors for cutout failure.Conclusion The present study identified poor reduction quality and TAD ≥25 mm as factors for cutout failure in geri-atric intertrochanteric fractures treated with cephalomedullary nails.Further studies are needed to calculate the optimal TAD for cephalomedullary nails.关键词
髋骨折/老年人/骨折固定术,髓内/内固定失败Key words
Hip fractures/Aged/Fracture fixation,intramedullary/Internal fixation failure分类
临床医学引用本文复制引用
郝有亮,周方,姬洪全,田耘,张志山,郭琰,吕扬,杨钟玮,侯国进..髓内钉固定治疗老年股骨转子间骨折髋螺钉切出的危险因素分析[J].中国骨伤,2025,38(2):141-147,7.基金项目
国家重点研发计划(编号:2018YFF0301102) （编号:2018YFF0301102）
北京大学第三医院临床重点项目(编号:BYSYZD2023040)National Key R&D Program of China(No.2018YFF0301102) （编号:BYSYZD2023040）
