摘要
目的探讨生物型加长柄关节置换与股骨近端防旋髓内钉治疗高龄股骨转子间不稳定骨折的疗效。方法回顾性选取80例2016年1月至2020年1月太和县人民医院收治的高龄股骨转子间不稳定骨折患者作为研究对象。纳入标准:股骨转子间不稳定骨折;患侧为初次手术。排除标准:患肢伤前存在功能障碍;严重骨质疏松症导致股骨皮质骨异常菲薄;严重骨肿瘤。根据治疗方法的不同将其分为内固定组(40例)和关节置换组(40例)。内固定组给予股骨近端防旋髓内钉进行治疗,关节置换组给予生物型加长柄关节置换进行治疗,两组术后均随访1年。采用独立样本t、配对t检验及卡方检验比较两组手术指标,术前、术后3周的髋关节功能、生活质量及随访1年的并发症发生率。结果关节置换组术中失血量高于内固定组(t=5.514,P<0.001),手术时间长于内固定组(t=6.520,P<0.001),术后引流量低于内固定组(t=3.900,P<0.001),术后下地时间短于内固定组(t=5.419,P<0.001)。与术前比,术后3周,两组畸形、活动、疼痛、功能评分、Harris髋关节评分(HHS)总分及躯体疼痛、活力、社会功能、总体健康评分升高(关节置换组:t=19.578、41.350、35.154、20.180、29.849、96.274、109.390、45.900、61.437,均为P<0.001;内固定组:t=5.966、24.298、35.154、20.180、29.849、15.805、22.269、13.550、15.884,均为P<0.001),关节置换组高于内固定组(t=13.969、23.917、7.911、5.980、9.251、15.805、22.269、13.550、15.884,均为P<0.001)。随访1年,关节置换组并发症发生率为5.0%,低于内固定组的27.5%(t=7.440,P<0.05)。结论生物型加长柄关节置换与股骨近端防旋髓内钉治疗高龄股骨转子间不稳定骨折各有优劣。股骨近端防旋髓内钉具有术中失血量少、手术时间短的优势;而生物型加长柄髋关节置换具有患者术后恢复快、髋关节功能恢复好、生活质量高及术后并发症少的优势。
Objective To investigate the curative effect of biological long-stem joint replacement and proximal femoral anti-rotation intramedullary nail in the treatment of unstable intertrochanteric fractures of femur in the elderly patients.Methods Eighty elderly unstable femoral intertrochanteric fractures of femur patients were retrospectively admitted to the Tai-he County People’s Hospital from January 2016 to January 2020 were selected as the research objects.Inclusion criteria:unstable intertrochanteric fracture of the femur;the affected side was the first operation.Exclusion criteria:dysfunction of the affected limb before injury;severe osteoporosis leading to abnormal thinning of the femoral cortical bone;severe bone tumors.The patients were divided into the internal fixation group(40 cases)and the joint replacement group(40 cases)according to different treatment methods.The internal fixation group were treated with a proximal femoral anti-rotation in tramedullary nail,and the joint replacement group were treated with a biological long-stem joint replacement.Both groups were followed up for one year after surgery.The operation indicators,the hip joint function,quality of life before and three weeks after operation,and the incidence of complications followed up one year of the two groups were compared and used independent sample t test,paired t test and chi-square test.Results The intraoperative blood loss of the joint replacement group was higher than that of the internal fixation group(t=5.514,P<0.001).The operation time was longer than that of the internal fixation group(t=6.520,P<0.001).The postoperative drainage volume was lower than that of the internal fixation group(t=3.900,P<0.001),and the time of postoperative landing was shorter than that of the internal fixation group(t=5.419,P<0.001).Compared with the preoperative data,the scores of deformity,mobility,pain,functional,the total score of Harris hip score(HHS),and the scores of physical pain,vitality,social function,and overall health of the two groups increased three weeks after operation(the joint replacement group:t=19.578,41.350,35.154,20.180,29.849,96.274,109.39,45.90 and 61.437,all P<0.001;the internal fixation group:t=5.966,24.298,35.154,20.18,29.849,15.805,22.269,13.55 and 15.884,all P<0.001),and the joint replacement group was higher than the internal fixation group(t=13.969,23.917,7.911,5.980,9.251,15.805,22.269,13.550 and 15.884,all P<0.001).At one year of follow-up,the rate of complication in the joint replacement group was 5.0%,which was lower than that(27.5%)in the internal fixation group(t=7.440,P<0.05).Conclusions Biological long-stem joint replacement and proximal femoral anti-rotation intramedullary nail have their own advantages and disadvantages in the treatment of unstable intertrochanteric fractures of femur in the elderly patients.The proximal femoral anti-rotation intramedullary nail shows the advantages of less intraoperative blood loss and short operation time,while the biological long-stem joint replacement shows the advantages of fast postoperative recovery,good hip function recovery,high quality of life and fewer postoperative complications.
作者
刘思杰
刘哲华
李海亚
张宏伟
范晓东
张敬堂
Liu Sijie;Liu Zhehua;Li Haiya;Zhang Hongwei;Fan Xiaodong;Zhang Jingtang(Department of Orthopedics,the Tai-he County People’s Hospital,Fuyang 236600,China)
出处
《中华关节外科杂志（电子版）》
CAS
CSCD
2021年第4期397-403,共7页
Chinese Journal of Joint Surgery(Electronic Edition)
关键词
髋骨折
老年人
关节成形术
置换
髋
骨折固定术
髓内
治疗效果
Hip fractures
Aged
Arthroplasty,replacement,hip
Fracture fixation,intramedullary
Treatment outcome
