本研究旨在综述微创技术在老年股骨转子间骨折治疗中的最新进展,评估其临床效果及对患者预后的影响。通过系统检索近五年的国内外相关文献,分析了髓内固定和微创关节置换术在临床应用中的效果。近年来,髓内固定因其创伤小、恢复快,能够显著提高内固定的稳定性并减少并发症,逐渐成为治疗首选。微创全髋关节置换术在特定患者群体中提供了长期稳定性,减少了再次手术需求,并显著提升了术后恢复质量。此外,手术时机对术后恢复和并发症发生率具有重要影响,早期手术干预能够显著改善患者预后,缩短卧床时间,减少并发症。综上所述,微创技术在老年股骨转子间骨折治疗中具有重要的临床应用价值,但仍需进一步优化技术、加强骨质疏松管理及开发个性化治疗方案,以提升患者的生活质量和术后功能恢复。This study aims to review the latest advancements in minimally invasive techniques for the treatment of intertrochanteric femoral fractures in the elderly, evaluating their clinical efficacy and impact on patient prognosis. By systematically retrieving and analyzing relevant domestic and international literature from the past five years, this review examines the clinical outcomes of intramedullary fixation and minimally invasive hip arthroplasty. In recent years, intramedullary fixation has gradually become the treatment of choice due to its minimal trauma, rapid recovery, enhanced stability of internal fixation, and reduced complications. Minimally invasive total hip arthroplasty provides long-term stability in appropriately selected patients, decreases the need for subsequent surgeries, and significantly improves postoperative functional recovery. Additionally, the timing of surgery plays a crucial role in postoperative recovery and the incidence of complications. Early surgical intervention can markedly improve patient prognosis, shorten bed rest duration, and reduce the occurrence of
目的:探讨老年股骨转子间骨折患者接受髓内钉固定术后发生髋螺钉切出的危险因素。方法:回顾性分析2008年1月到2018年8月接受髓内钉治疗的518例股骨转子间骨折老年患者资料,其中,男167例,女351例;年龄65~97岁。根据是否发生髋螺钉切出,将其分为愈合组508例和切出组10例。对两组患者的一般资料、手术资料、影像学资料进行比较,再按照性别、年龄、身体质量指数(body mass index,BMI)、美国麻醉师协会(American Society of Anesthesiologists,ASA)对切出组进行倾向性评分匹配,按照1∶4的比例,匹配出愈合组40例。对影响髋螺钉切出的潜在危险因素进行分析,采用多因素Logistic回归模型对影响髋螺钉切出的独立危险因素进行分析。结果:愈合组和切出组患者在年龄、性别、BMI、ASA分级、AO分型方面的差异均无统计学意义,两组在复位质量方面的差异具有统计学意义(P=0.003),两组在尖顶距方面的差异具有统计学意义(P<0.001)。多因素Logistic回归分析显示复位质量差[OR=23.138,95%CI(2.163,247.551),P=0.009]和尖顶距≥25 mm[OR=30.538,95%CI(2.935,317.770),P=0.004]是导致髋螺钉切出的独立危险因素。结论:复位质量差和尖顶距≥25 mm是老年股骨转子间骨折患者接受髓内钉固定术治疗时发生髋螺钉切出的独立危险因素。尖顶距的最佳数值仍有待进一步研究。
