摘要
目的探讨复合加压系统(CCS)固定对股骨颈骨折的疗效及对关节功能和成骨指标的影响。方法回顾性选择2021年1月至2022年12月来攀枝花市中心医院诊治的股骨颈骨折患者80例作为研究对象。按照治疗方式不同分为观察组和对照组,每组各40例。对照组行闭合复位经皮空心钉内固定治疗,观察组行CCS固定治疗。比较两组围术期指标(术中失血量、手术时间、骨折愈合时间),比较两组术前、术后1周、术后1个月的Harris评分,比较两组术前及术后1个月的运动功能[步行能力评分、Fugl-Meyer运动功能评分量表(FMES)评分]、成骨指标[Ⅰ型前胶原氨基端原肽(PINP)、抗酒石酸酸性磷酸酶(TRACP-5b)、骨钙素(BGP)、成纤维细胞因子(FGF)、骨源性碱性磷酸酶(BAP)及Ⅰ型胶原羧基端前肽(PICP)]、疼痛介质[5-羟色胺(5-HT)、前列腺素E2(PGE2)]水平,并比较两组术后并发症发生情况。结果观察组术中失血量为(35.67±4.13)mL,低于对照组,手术时间、骨折愈合时间分别为(45.10±5.23)min、(3.19±0.41)个月,均短于对照组,差异均有统计学意义(P<0.05)。术后1周、术后1个月,两组Harris评分均较术前明显升高,且观察组Harris评分分别为(85.88±9.12)、(92.78±5.12)分,均明显高于对照组,差异均有统计学意义(P<0.05)。术后1个月,两组步行能力评分均较术前降低,FMES评分均较术前升高,且观察组步行能力评分为(1.45±0.34)分,低于对照组,FMES评分为(25.78±3.56)分,高于对照组,差异均有统计学意义(P<0.05)。术后1个月,两组PINP、BGP、FGF、BAP、PICP水平均较术前明显升高,TRACP-5b较术前降低,且观察组PINP、BGP、FGF、BAP、PICP水平分别为(1054.67±123.14)pg/L、(9.63±1.43)ng/mL、(11.24±1.56)ng/mL、(43.89±5.12)ng/mL、(18.98±2.88)ng/mL,均明显高于对照组,TRACP-5b水平为(0.89±0.14)U/L,低于对照组,差异均有统计学意义(P<0.05)。术后1个月,两组5-HT、PGE2水平均较术前明显降低,且观察组5-HT、PGE2水平分别为(83.89±15.23)、(84.89±14.34)ng/L,均低于对照组,差异均有统计学意义(P<0.05)。观察组与对照组的术后并发症发生率比较,差异无统计学意义(P>0.05)。结论CCS固定可提高股骨颈骨折的疗效,改善患者的关节功能和成骨指标,降低疼痛介质水平,且应用安全,值得临床推广应用。
Objective To investigate the curative effect of compound compress system(CCS)fixation in the treatment of femoral neck fracture and its influence on joint function and osteogenic indexes.Methods A total of 80 patients with femoral neck fracture who were treated in Panzhihua Central Hospital from January 2021 to December 2022 were retrospectively selected as the study subjects.According to different treatment methods,they were divided into the observation group and the control group,with 40 cases in each group.The control group was treated with closed reduction and percutaneous hollow nail internal fixation,and the observation group was treated with CCS fixation.The perioperative indexes(intraoperative blood loss,operation time,fracture healing time)were compared between the two groups,Harris scores before surgery,one week after surgery and one month after surgery,motor function[walking ability score,Fugl-Meyer exercise scale(FMES)score],osteogenic indexes[procollagen typeⅠN-terminal propeptide(PINP),tartrate-resistant acid phosphatase 5b(TRACP-5b),bone gla protein(BGP),fibroblast growth factor(FGF),bone alkaline phosphatase(BAP),procollagen type I carboxy-terminal propeptide(PICP)]and pain mediators[5-hydroxytryptamine(5-HT),prostaglandin E2(PGE2)]before surgery and one month after surgery were compared between the two groups,and postoperative complications were compared between the two groups.Results The intraoperative blood loss in the observation group was(35.67±4.13)mL,which was lower than that in the control group.The surgery time and fracture healing time were(45.10±5.23)minutes and(3.19±0.41)months,respectively,which were shorter than those in the control group,and the differences were statistically significant(P<0.05).One week and one month after surgery,the Harris scores of two groups were significantly higher than those before surgery,and the Harris scores of the observation group were(85.88±9.12)and(92.78±5.12)points,respectively,which were significantly higher than those of the control group,and the differences were statistically significant(P<0.05).One month after surgery,the walking ability scores of two groups were significantly lower than those before surgery,while the FMES scores were significantly higher than those before surgery,the walking ability score of the observation group was(1.45±0.34)points,which was lower than that of the control group,and the FMES score was(25.78±3.56)points,which was higher than that of the control group,and the differences were statistically significant(P<0.05).One month after surgery,the levels of PINP,BGP,FGF,BAP,and PICP in the two groups were significantly higher than those before surgery,while TRACP-5b in the two groups were significantly lower than those before surgery,and the levels of PINP,BGP,FGF,BAP,and PICP in the observation group were(1054.67±123.14)pg/L,(9.63±1.43)ng/mL,(11.24±1.56)ng/mL,(43.89±5.12)ng/mL,and(18.98±2.88)ng/mL,respectively,which were significantly higher than those in the control group,the levels of TRACP-5b was(0.89±0.14)U/L,which was lower than that in the control group,and the differences were statistically significant(P<0.05).One month after surgery,the levels of 5-HT and PGE2 in the two groups were significantly higher than those before surgery,and the levels of 5-HT and PGE2 in the observation group were(83.89±15.23)and(84.89±14.34)ng/L,respectively,which were lower than those in the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of postoperative complications between the observation group and the control group(P>0.05).Conclusion CCS fixation can improve the curative effect of femoral neck fracture,improve the joint function and osteogenic index of patients,reduce the level of pain mediators,and is safe to apply,which is worthy of clinical application.
作者
何荣富
梁羽
刘绍江
HE Rong-fu;LIANG Yu;LIU Shao-jiang(Department of Orthopedics,Panzhihua Central Hospital,Panzhihua Sichuan 617000,China)
出处
《临床和实验医学杂志》
2024年第13期1407-1411,共5页
Journal of Clinical and Experimental Medicine
基金
四川省医学会骨科疾病专项科研课题(编号:20210206070037)。
关键词
复合加压系统固定
闭合复位经皮空心钉内固定
股骨颈骨折
疗效
Compound compress system fixation
Closed reduction percutaneous hollow nail internal fixation
Femoral neck fracture
Curative effect
