老年股骨转子间骨折术中复位质量对术后功能预后的影响

Influence of intraoperative reduction quality on postoperative functional prognosis in elderly patients with intertrochanteric femoral fractures

摘要

目的 探讨术中C型臂影像评估老年股骨转子间骨折复位质量的价值，分析其与术后三维计算机断层扫描（3D-CT）结果的相关性，以及复位质量对术后预后的影响。方法 回顾性分析2022年1月至2023年12月解放军总医院第七医学中心骨科收治的老年股骨转子间骨折患者资料，结合患者术中C型臂影像和术后3D-CT资料，评估术中C型臂影像的准确度，研究复位质量与术后并发症、头钉滑移位移及患肢功能的关系。结果 142例患者符合纳入排除标准，平均年龄（81.6±9.2）岁，其中男47例，女95例，104例患者正位和侧位均为正性或中性复位，经术后3D-CT验证，股骨近端皮质完全达到有效支撑；26例正位为正性或中性复位，侧位为负性复位，术后3D-CT验证80.8%的患者股骨近端皮质为负性支撑；6例正位为负性复位，侧位为正性或中性复位，术后3D-CT验证33.3%的患者股骨近端皮质为负性支撑；6例正位和侧位皮质均为负性复位，术后3D-CT验证股骨近端皮质均为负性支撑。和正性或中性复位组相比，负性复位组患者术后内固定并发症发生率高，头钉滑移距离多，术后Harris评分低，两组相比，达到统计学差异（P<0.05）。结论 建议使用术中股骨近端前内侧皮质支撑做为股骨转子间骨折的复位标准，如前内侧皮质影像正侧位一致，准确度最高，如正侧位不一致，建议参考侧位影像；稳定的股骨近端前内侧皮质支撑不仅可以降低术后内固定并发症，还可以最大程度保留肢体功能。

Abstract

Objective To accurately assess the quality of reduction in elderly patients with intertrochanteric fractures using intraoperative C-arm fluoroscopy and to analyze its correlation with postoperative three-dimensional tomography (3D-CT) findings as well as the impact of reduction quality on prognosis. Methods A retrospective analysis was conducted on data from elderly patients with intertrochanteric fractures treated in Department of Orthopedics, the 7th Medical Center of PLA General Hospital from January 2022 to December 2023. Intraoperative C-arm imaging and postoperative 3D-CT data were used to evaluate the accuracy of intraoperative C-arm fluoroscopy and to assess the quality of reduction and its impact on postoperative complications, head nail slippage distance, and limb function. Results A total of 142 patients met the inclusion criteria, with an average age of 81.6 ± 9.2 years, including 47 males and 95 females. Among them, 104 patients had positive or neutral reduction in both the anteroposterior (AP) and lateral views, and postoperative 3D-CT confirmed effective support of the proximal femoral cortex. In 26 cases with positive or neutral reduction in the AP view but negative reduction in the lateral view, 80.8% of patients showed negative support in the proximal femoral cortex on postoperative 3D-CT. Six cases had negative reduction in the AP view but positive or neutral reduction in the lateral view, with 33.3% showing negative support on 3D-CT. Six cases had negative reduction in both views, and all showed negative support on 3D-CT. Compared to the positive or neutral reduction group, the negative reduction group had a higher incidence of internal fixation complications, greater head nail slippage distance, and lower postoperative Harris scores, with statistically significant differences. Conclusions It is recommended to use intraoperative anterior medial cortical support as the reduction standard for intertrochanteric fractures. If the anterior medial cortical images are consistent in both AP and lateral views, the accuracy is highest. If the views are inconsistent, the lateral view should be referenced. Stable anterior medial cortical support of the proximal femur not only reduces postoperative internal fixation complications but also maximizes limb function preservation.

关键词

老年人 / 骨折切开复位 / 手术后并发症 / 股骨转子间骨折

Key words

Aged / Open fracture reduction / Postoperative complications / Intertrochanteric fracture

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基金资助

国家自然科学基金面上项目(82172389)

北京科技新星计划(Z181100006218031)