摘要
对比单用股骨近端防旋髓内钉与联合解剖型锁定钢板治疗老年不稳定型股骨粗隆间骨折的效果。方法研究对象均为2021年1月—2022年12月莆田九十五医院收治的62例老年不稳定型股骨粗隆间骨折患者,随机分为观察组和对照组,各31例。观察组采用股骨近端防旋髓内钉联合解剖型锁定钢板治疗,对照组单用股骨近端防旋髓内钉治疗。比较2组围手术期指标、炎症因子水平、骨代谢指标水平、髋关节功能、并发症发生情况。结果观察组手术时间[(81.45±11.63)min]长于对照组[(63.71±9.24)min],术中出血量[(165.41±22.74)m L]多于对照组[(127.82±24.32)mL],负重时间[(11.93±2.76)d]、骨折愈合时间[(10.42±2.07)周]短于对照组[(15.38±3.59)d、(13.92±2.43)周],差异有统计学意义(t=6.650、6.286、4.242、6.105,P<0.001)。手术后1个月,观察组白细胞介素-1水平(39.07±5.37)pg/mL,白细胞介素-6水平(32.14±2.72)pg/mL,肿瘤坏死因子-α水平(30.97±2.16)pg/mL,均低于对照组[(48.14±6.23)pg/mL、(43.66±3.25)pg/mL、(37.32±2.87)pg/mL],差异有统计学意义(t=6.139、15.135、9.843,P<0.001)。手术后1个月,观察组Ⅰ型胶原羧基末端肽水平[(472.91±25.24)ng/L]低于对照组[(521.46±27.63)ng/L],观察组Ⅰ型前胶原氨基端前肽水平[(84.59±9.20)ng/mL]高于对照组[(73.61±8.64)ng/mL],差异有统计学意义(t=7.223、4.844,P<0.001)。观察组髋关节优良率(93.55%)高于对照组(74.19%),差异有统计学意义(χ^(2)=4.292,P=0.038)。观察组并发症发生率(3.23%)低于对照组(19.35%),差异有统计学意义(χ^(2)=4.026,P=0.045)。结论股骨近端防旋髓内钉联合股骨近端解剖型锁定钢板治疗老年不稳定型股骨粗隆间骨折患者的效果较好,可以缓解炎症反应,促进骨质修复,抑制骨吸收,提高髋关节功能,降低并发症发生率。
Objective To explore the clinical effect of proximal femoral antirotation intramedullary nail combined with anatomic locking plate in the treatment of unstable intertrochanteric femoral fractures in the elderly.Methods Sixty-two elderly patients with unstable intertrochanteric fracture of femur in Putian 95 Hospital from January 2021 to December 2022 were selected as the study objects,and randomly divided into observation group and control group,with 31 cases in each group.The observation group was treated with proximal femoral antirotation intramedullary nailing combined with anatomic locking plate,while the control group was treated with proximal femoral antirotation intramedullary nailing.Compared the perioperative indicators,serum inflammatory factors and bone metabolism levels,hip joint function,and incidence of complications between two groups.Results The operation time[(81.45±11.63)min]in the observation group was longer than that in the control group[(63.71±9.24)min],and the amount of intraoperative blood loss[(165.41±22.74)mL]was longer than that in the control group[(127.82±24.32)mL],weight bearing time[(11.93±2.76)d]and fracture healing time[(10.42±2.07)weeks]were shorter than control group[(15.38±3.59)d,(13.92±2.43)weeks],the differences were statistically significant(t=6.650,6.286,4.242,6.105,P<0.001).One month after the surgery,the levels of interleukin-1,interleukin-6,tumor necrosis factor-α[(39.07±5.37)pg/mL,(32.14±2.72)pg/mL,(30.97±2.16)pg/mL]in observation group were lower than those in control group[(48.14±6.23)pg/mL,(43.66±3.25)pg/mL,(37.32±2.87)pg/mL],the differences were statistically significant(t=6.139,15.135,9.843,P<0.001).One month after operation,the level of carboxyl terminal peptide of typeⅠcollagen in the observation group[(472.91±25.24)ng/L]was lower than that in the control group[(521.46±27.63)ng/L],the level of amino terminal propeptide of typeⅠprocollagen in the observation group[(84.59±9.20)ng/mL]was higher than that in the control group[(73.61±8.64)ng/mL],and the differences were statistically significant(t=7.223,4.844,P<0.001).The excellent rate of hip joint in observation group(93.55%)was higher than that in control group(74.19%),and the difference was statistically significant(χ^(2)=4.292,P=0.038).The complication rate of the observation group(3.23%)was lower than that of the control group(19.35%),and the difference was statistically significant(χ^(2)=4.026,P=0.045).Conclusion Proximal femoral antirotation intramedullary nail combined with proximal femoral anatomic locking plate is effective in the treatment of elderly patients with unstable intertrochanteric fractures,which can alleviate inflammatory response,promote bone repair,inhibit bone resorption,improve hip function and reduce the incidence of complications.
作者
林智星
林正龙
LIN Zhixing;LIN Zhenglong(Department of Orthopedics,Putian 95 Hospital,Putian Fujian 351100,China)
出处
《中国卫生标准管理》
2024年第13期94-98,共5页
China Health Standard Management
关键词
股骨近端防旋髓内钉
股骨粗隆间骨折
股骨近端解剖型锁定钢板
并发症
炎症因子
骨代谢
proximal femoral antirotation intramedullary nail
intertrochanteric fracture of femur
anatomic locking plate for proximal femur
complications
inflammatory factors
bone metabolism
