摘要
目的:比较股骨近端髓内钉(proximal femoral nail antirotation,PFNA)与动力髋螺钉(dynamic hip screw,DHS)对老年不稳定型股骨粗隆间骨折患者术后疼痛应激、骨代谢、凝血指标的影响。方法:选取2019年1月至2020年12月衡水市第四人民医院骨科收治的240例老年不稳定型股骨粗隆间骨折患者作为研究对象,根据手术方法分为DHS组(n=124)与PFNA组(n=116)。比较2组患者的手术指标、疗效指标。对2组患者术前和术后24 h的视觉模拟评分法(Visual Analogue Scale,VAS)评分及血清前列腺素E_(2)(prostaglandin E_(2),PGE_(2))、P物质(substance P,SP)、5-羟色胺(5-hydroxy tryptamine,5-HT)、去甲肾上腺素(norepinephrine,NE)及血管紧张素II(angiotensin II,AngII)水平进行比较。对2组患者术前和术后3个月的血浆甲状旁腺素(parathyroid hormone,PTH)、骨钙素(osteocalcin,BGP)、骨碱性磷酸酶(bone alkaline phosphatase,BALP)、I型前胶原氨基端前肽(procollagen type I Nterminal propeptide,PINP)、I型前胶原羟基端肽(propeptide of type I procollagen,PICP)、I型胶原羧基端肽β特殊序列(beta C-terminal cross-linked telopeptides of type I collagen,β-CTX)、25-二羟维生素D3[25-dihydroxyvitamin D3,25-(OH)2D3]、纤维蛋白原(fibrinogen,FBG)、D-二聚体水平及凝血活酶时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)进行比较。结果:PFNA组患者的手术时间、术中出血量、骨折愈合时间均低于DHS组,差异均有统计学意义(均P<0.05)。PFNA组患者术后6个月的Harris评分高于DHS组,差异有统计学意义(P<0.05)。PFNA组患者术后24 h的VAS评分、血清PGE_(2)、SP、5-HT、NE、AngII水平均低于DHS组,差异均有统计学意义(均P<0.05)。PFNA组患者术后3个月的血浆PTH、25-(OH)2D3、BGP、BALP、PINP、PICP水平均高于DHS组,血浆β-CTX、FBG、D-二聚体水平及PT、APTT均低于DHS组,差异均有统计学意义(均P<0.05)。结论:在老年不稳定型股骨粗隆间骨折的内固定手术治疗中,与DHS比较,PFNA在提升疗效、减少手术创伤、减轻术后疼痛应激、改善骨代谢指标和凝血功能指标方面具有更好的效果,临床医师应根据患者实际情况合理选择术式,以达到改善患者预后、减少并发症的目的。
Objective:To compare and analyze the effects of proximal femoral nail antirotation(PFNA)and dynamic hip screw(DHS)on postoperative pain stress,bone metabolism,and coagulation indexes in elderly patients with unstable intertrochanteric femoral fracture.Methods:A total of 240 elderly patients with unstable intertrochanteric femoral fracture treated in the Department of Orthopedics of Hengshui Fourth People’s Hospital from January 2019 to December 2020 were selected as research subjects.They were divided into a DHS group(n=124)and a PFNA group(n=116)according to the surgical methods.The operation indexes and curative effects indexes between the 2 groups were compared.The scores of Visual Analogue Scale(VAS)and the levels of serum prostaglandin E_(2)(PGE_(2)),substance P(SP),5-hydroxytryptamine(5-HT),norepinephrine(NE),and angiotensin II(AngII)before the operation and 24 h after the operation were compared between the 2 groups.The plasma levels of parathyroid hormone(PTH),osteocalcin(BGP),bone alkaline phosphatase(BALP),type I procollagen N-terminal propeptide(PINP),propeptide of type I procollagen(PICP),beta C-terminal cross-linked telopeptides of type I collagen(β-CTX),25-dihydroxyvitamin D3[25-(OH)2D3],fibrinogen(FBG),D-dimer levels and thromboplastin time(PT),activated partial thromboplastin time(APTT)before the operation and 3 months after operation between the 2 groups were compared.Results:The operation time,intraoperative bleeding,and fracture healing time of the patients in the PFNA group were lower than those in the DHS group,and the differences were statistically significant(all P<0.05).The Harris score of the patients in the PFNA group 6 months after the operation was higher than that in the DHS group,with the difference was statistically significant(P<0.05).The VAS score and the levels of serum PGE_(2),SP,5-HT,NE,and AngII of the patients in the PFNA group 24 h after the operation were significantly lower than those in the DHS group,and the differences were statistically significant(all P<0.05).The plasma levels of PTH,25-(OH)2D3,BGP,BALP,PINP,and PICP 3 months after the operation of the patients in the PFNA group were higher than those in the DHS group,whereas the levels ofβ-CTX,FBG,and D-dimer,PT,and APTT were lower than those in the DHS group,and the differences were statistically significant(all P<0.05).Conclusion:In the internal fixation treatment of unstable intertrochanteric femoral fracture in the elderly patients,compared with DHS,PFNA has higher effects in improving efficiency,reducing surgical trauma,alleviating postoperative pain and stress,and improving bone metabolism and coagulation indexes.Clinicians should reasonably select the operation method according to the actual situation of patients,in order to improve the prognosis of patients and reduce complications.
作者
王艳彬
韩晓军
刘志鹏
刘俊川
WANG Yanbin;HAN Xiaojun;LIU Zhipeng;LIU Junchuan(Department of Joint Orthopedics,Hengshui Fourth People’s Hospital,Hengshui Hebei 053000;Department of Orthopedics I,Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)
出处
《临床与病理杂志》
CAS
2023年第3期556-564,共9页
Journal of Clinical and Pathological Research
基金
衡水市科技计划项目(2017014013C-36)。
关键词
股骨近端髓内钉
动力髋螺钉
老年
不稳定型股骨粗隆间骨折
疼痛应激
骨代谢
凝血指标
proximal femoral nail antirotation
dynamic hip screw
elderly
unstable intertrochanteric femoral fracture
pain stress
bone metabolism
coagulation indexes
