目的：探讨老年股骨粗隆间骨折（IFOF）患者行机器人辅助股骨近端防旋髓内钉（PFNA）内固定治 疗预后不良的影响因素及应对策略。方法：选取 2022 年 5 月—2024 年 5 月宝鸡市中心医院行机器人辅助 PFNA 内 固定手术的老年 IFOF 患者 136 例。根据术后 12 个月 Harris 髋关节功能量表评分结果，分为预后良好组（≥ 80 分） 与预后不良组（<80 分）。采用单因素、多因素 Logistic 回归分析预后不良危险因素，建立风险预测模型，分析模型 价值并验证。结果：年龄偏高、术前美国麻醉医师协会（ASA）分级 > Ⅱ级、骨折Ⅲ ~ Ⅳ型、术后引流量偏高、术 后负重时间过长为老年 IFOF 患者预后不良的独立危险因素（P<0.05），风险预测模型曲线 AUC 值为 0.978（95%CI： 0.953~1.000），当取 Cut-off 值时，模型敏感度、特异度分别为 0.927、0.963。Bootstrap 内部验证显示该模型预测效 能较为稳定，决策分析显示该模型有正向净收益率。结论：年龄偏高、术前 ASA 分级 > Ⅱ级、骨折Ⅲ ~ Ⅳ型、术 后引流量偏高、术后负重时间过长为老年 IFOF 患者行机器人辅助 PFNA 内固定手术治疗预后不良的独立危险因素， 基于预后不良危险因素建立的风险列线图模型预测效能较好且稳定，可用于指导临床决策。

Objective: To investigate the influencing factors to robot-assisted proximal femoral nail antirotation (PFNA) internal fixation for poor prognosis of intertrochanteric fracture of femur (IFOF) in the elderly and provide corresponding strategies. Methods: 136 aged IFOF patients who underwent robot-assisted PFNA internal fixation in Baoji Central Hospital from May 2022 to May 2024 were selected. According to the results of Harris hip score (HHS) at 12 months after surgery, they were divided into the good prognosis group (HHS≥80) and the poor prognosis group (HHS<80). The risk factors for poor prognosis were analyzed using univariate and multivariate Logistic regression, and a risk prediction model was established to analyze its value and validate it. Results: Higher age, preoperative American Society of Anesthesiologists classification (ASA)>grade Ⅱ , Ⅲ-Ⅳ types of fracture, high postoperative drainage, and prolonged postoperative weight-bearing time were the independent risk factors to poor prognosis in elderly patients with IFOF (P<0.05), and the AUC value of the risk prediction model was 0.978 (95% CI: 0.953-1.000). When the Cut-off value was taken, the sensitivity and specificity of the model were 0.927 and 0.963, respectively. Bootstrap internal validation showed that the predicting efficacy of the model was relatively stable, and decision analysis showed that the model had a positive net yield. Conclusion: High age, preoperative ASA classification>grade Ⅱ , Ⅲ-Ⅳ types of fracture, high postoperative drainage, and prolonged postoperative weight-bearing time are independent risk factors to poor prognosis of elderly patients with IFOF who underwent robot-assisted PFNA internal fixation, and the risk nomogram model based on the risk factors to poor prognosis has a better predictive efficacy and stability, which can be used to guide clinical decision-making.

收稿日期：2024-05-30  录用日期：2024-07-23 

Received Date: 2024-05-30  Accepted Date: 2024-07-23 

基金项目：陕西省重点研发计划项目（2021SF-353） 

Foundation Item: Key R & D Plan Project of Shaanxi Province (2021SF-353) 

通讯作者：张敏，Email：13772635407@163.com 

Corresponding Author: ZHANG Min, Email: 13772635407@163.com 

引用格式：郭佳，张敏 . 机器人辅助近端防旋髓内钉内固定治疗老年股骨粗隆间骨折预后不良的预测研究及策略分析 [J]. 机器人外 科学杂志（中英文），2024，5（5）：789-795. 

Citation: GUO J, ZHANG M. Risk factors and strategies to robot-assisted proximal femoral nail antirotation internal fixation for poor prognosis of intertrochanteric fracture of femur in the elderly [J].Chinese Journal of Robotic Surgery, 2024, 5(5): 789-795.

[1] Ghasemi F, Esmaeilnejad-Ganji S M, Manafi Rasi A, et al. Evaluation of quality of life and associated factors in patients with intertrochanteric femoral fracture[J]. PLoS One, 2023, 18(11): e0293686. 

[2] Sivakumar A, Rickman M, Thewlis D. Gait biomechanics after proximal femoral nailing of intertrochanteric fractures[J]. J Orthop Res, 2023, 41(4): 862-874. 

[3] 张佳凤 , 姚丹华 , 王小文 . 股骨粗隆间骨折患者报告结局现状 及相关因素研究 [J]. 中国卫生统计 , 2021, 38(5): 755-758. 

[4] Faust L M, Lerchenberger M, Gleich J, et al. Predictive value of prognostic nutritional index for early postoperative mobility in elderly patients with pertrochanteric fracture treated with intramedullary nail osteosynthesis[J]. J Clin Med, 2023, 12(5): 1792. 

[5] Jegathesan T, Kwek E B K. Are intertrochanteric fractures evolving? Trends in the elderly population over a 10-year period[J]. Clin Orthop Surg, 2022, 14(1): 13-20. 

[6] Ramezani A, Babagoli M, Ghaseminejad-Raeini A, et al. Factors associated with postoperative quality of life in patients with intertrochanteric fracture[J]. Ann Med Surg (Lond), 2023, 86(2): 703-711. 

[7] 胡春祥 , 黄建国 , 黄永红 , 等 . 八珍汤联合股骨近端防旋髓内钉 内固定对老年股骨粗隆间骨折患者髋关节功能及骨代谢的影响 [J]. 中国老年学杂志 , 2023, 43(2): 310-313. 

[8] 张朕 , 刘华水 , 段升军 , 等 . 机器人辅助 PFNA 与传统手术治疗 股骨粗隆间骨折的疗效比较 [J]. 中华老年骨科与康复电子杂志 , 2020, 6(1): 25-30. 

[9] SHI J X, SHEN J X, ZHANG C C, et al. Robot-assisted versus traditional surgery in the treatment of intertrochanteric fractures: a meta-analysis[J]. J Robot Surg, 2024, 18(1): 221. 

[10] XU Z M, ZHANG X , WANG Y Q, et al. Comparison of bonesetting robots and conventional reduction in the treatment of intertrochanteric fracture: a retrospective study[J]. Orthop Surg, 2024, 16(2): 312-319. 

[11] LI X P, ZHANG P, ZHU S W, et al. All-cause mortality risk in aged femoral intertrochanteric fracture patients[J]. J Orthop Surg Res, 2021, 16(1): 727. 

[12] 郭金伟 , 杨川 , 杨博文 , 等 . 股骨粗隆间骨折 PFNA 术中改良克 氏针固定的应用分析 [J]. 重庆医学 , 2022, 51(4): 650-653, 657. 

[13] Boyd H B, Griffin L L. Classification and treatment of trochanteric fractures[J]. Arch Surg (1920), 1949, 58(6): 853-866. 

[14] Adulkasem N, Phinyo P, Khorana J, et al. Prognostic factors of 1-year postoperative functional outcomes of older patients with intertrochanteric fractures in Thailand: a retrospective cohort study[J]. Int J Environ Res Public Health, 2021, 18(13): 6896. 

[15] ZHAO L, LI H R, ZHANG S H, et al. Serum HMGB1 levels and its clinical significance in elderly patients with intertrochanteric fractures after intramedullary fixation surgery[J]. Medicine (Baltimore), 2023, 102(8): e32873. 

[16] GU J, HE S, WANHG L. Analysis of one-year postoperative mortality and risk factors of elderly patients with intertrochanteric fractures after PFNA[J]. Niger J Clin Pract, 2022, 25(9): 1557-1562. 

[17] 胡靖 , 王林 , 陈义 , 等 . 防旋股骨近端髓内钉治疗老年股骨粗隆 间骨折的效果及对髋关节功能、生活质量和日常生活能力的影 响 [J]. 中国老年学杂志 , 2022, 42(12): 2918-2920. 

[18] 陆锡平 , 王科 , 闫文千 . 高压氧联合旋刀片式股骨近端髓内钉 内固定治疗对股骨粗隆间骨折患者血液流变学指标、骨折愈合 及关节功能的影响 [J]. 中华航海医学与高气压医学杂志 , 2021, 28(1): 30-33. 

[19] 丁庆丰 , 王晟昊 , 吴贵忠 , 等 . 两种髓内钉固定骨质疏松股骨粗 隆间骨折的比较 [J]. 中国矫形外科杂志 , 2022, 30(2): 97-101. 

[20] 武英楷 , 王瑞强 , 宁尚攀 , 等 . 股骨近端防旋髓内钉固定股骨 粗隆间骨折失败的因素 [J]. 中国矫形外科杂志 , 2022, 30(22): 2050-2054. 

[21] 刘明军 , 万先亮 , 李洪波 , 等 . 骨科创伤机器人辅助 PFNA 内 固定治疗老年股骨粗隆间骨折的效果 [J]. 实用老年医学 , 2023, 37(5): 491-494, 499. 

[22] Tüzün H Y, Bilekli A B, Erşen Ö. The factors that affect blood loss in intertrochanteric fractures treated with proximal femoral nail in the elderly[J]. Eur J Trauma Emerg Surg, 2022, 48(3): 1879-1884. 

[23] 马冰心 , 刘金山 , 金红光 , 等 . 股骨粗隆间骨折固定术后感染危 险因素及对 TGF-β/BMPs 信号通路和骨代谢指标影响 [J]. 中 华医院感染学杂志 , 2021, 31(23): 3581-3585. 

[24] 苏启旭 , 巴黎 , 王松 , 等 . PFNA 治疗老年股骨粗隆间骨折的效 果及影响因素 [J]. 中国老年学杂志 , 2020, 40(6): 1234-1236. 

[25] 赵继阳 , 陈卫衡 , 郭盛君 , 等 . PFNA 治疗老年股骨粗隆间骨折 术后功能康复影响因素分析 [J]. 中国医药导报 , 2023, 20(15): 82-85. 

[26] 洪石 , 吴征杰 , 李灿辉 . 机器人辅助下股骨近端防旋髓内钉内 固定治疗股骨粗隆间骨折 8 例 [J]. 实用医学杂志 , 2019, 35(2): 335-336. 

[27] 马志华 , 付宏伟 , 陈晓华 . 闭合复位髓内钉固定治疗同侧股骨 干合并股骨粗隆间骨折的临床疗效与不愈合危险因素分析 [J]. 中国临床解剖学杂志 , 2022, 40(2): 211-215.