Cause Analysis of Dislocation After Femoral Head Replacement Surgery in Elderly Patients with Failed Intramedullary Treatment of Femoral Intertrochanteric Fracture
10.3870/j.issn.1672-0741.24.08.011
- VernacularTitle:高龄股骨转子间骨折髓内治疗失败行人工股骨头置换术后脱位的原因分析
- Author:
Guorui ZHANG
1
;
Zhenjiang SUN
;
Yongshen XU
Author Information
1. 河南科技大学临床医学院,洛阳 450066;河南科技大学第一附属医院骨外科,洛阳 471003
- Publication Type:Journal Article
- Keywords:
senile;
femoral intertrochanteric fracture;
proximal femoral nail anti-rotation;
femoral head replacement
- From:
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
2025;54(2):247-254
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the cause of dislocation after femoral head replacement(FHR)surgery in elderly patients with failed intramedullary treatment of femoral intertrochanteric fracture(FIF).Methods Elderly patients(175 cases)with FIF who underwent FHR treatment due to failure of intramedullary nails after proximal femoral nail anti-rotation(PFNA)treatment in our hospital from December 2018 to January 2023 were selected as the research subjects.According to whether the femoral head was dislocated after FHR surgery,the patients were divided into dislocation group(45 cases)and non-dislocation group(130 cases).The clinical efficacy of FHR surgery was evaluated,and clinical data of patients(including age,gender,perioperative da-ta,etc.)was collected for comparative analysis.Multicollinearity of these factors was determined.LASSO regression analysis was used to screen for predictive factors.Based on multivariate logistic regression analysis of risk factors,simple risk scoring model was constructed using the odds ratio(OR)values of each risk factor.Receiver operating characteristic(ROC)curves were constructed to evaluate the discriminability of the model.Hosmer Lemeshow(H-L)test was used to judge the calibration of the model.Results Compared with preoperative,the Harris scores of patients at 1 and 12 months after surgery were significantly improved(P＜0.05).Postoperative complications in FHR patients were relatively low,mainly including pulmonary infection(2.86％),lower limb thrombosis(2.86％),and cardiac dysfunction(2.86％).The LASSO regression model obtained 6 predic-tive factors,among which age,neurological and muscular system diseases,surgical approach,postoperative lifestyle habits,and postoperative care were all independent influencing factors for the occurrence of femoral head dislocation(P＜0.05).The score of the simplified risk scoring model was 0～21.6 points,which can be divided into three risk levels:low risk(＜11 points),medi-um risk(11-15 points),and high risk(＞15 points).There was no significant difference in the incidence of dislocation between the two episodes of patients(P＞0.05).The model validation results showed good discrimination and calibration.Conclusion FHR can effectively improve hip joint function in elderly patients after failure of FIF intramedullary nail fixation,and there are fewer postoperative complications.Age,neurological and muscular system diseases,surgical approach,postoperative lifestyle habits,and postoperative care are independent influencing factors for the occurrence of femoral head dislocation,and should be taken seriously and prevented in clinical treatment.
