摘要
目的了解股骨近端防旋髓内钉(PFNA)治疗老年股骨转子间骨折的效果,同时探讨肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、IL-10的变化。方法选取秦皇岛市第二医院创伤关节科2015年8月至2018年5月收治的老年股骨转子间骨折患者100例为研究对象,按治疗方法不同分为2组:对照组、研究组,每组各50例。对照组采用股骨近端解剖锁定钢板(APFLP)内固定,患者于全身麻醉下取仰卧位。将股骨颈基底至小转子水平以上部位全部显露出来,将移位的骨折进行复位,复位满意后,固定解剖钢板及锁钉。研究组采用PFNA内固定,患者于全身麻醉下取仰卧位。C臂机透视下复位,选择合适的PFNA主钉,透视下见近端导针位置满意,顺导针打入合适的防旋刀片,远端通过瞄准器拧入1枚锁钉,最后安装主钉尾帽,术后透视见骨折复位及内固定位置满意。观察并对比术前、术后1周2组患者的血清TNF-α、IL-6、IL-10水平的改变及术后6个月2组患者的临床治疗效果。对数据行t检验、χ^(2)检验。结果术前研究组患者血清TNF-α、IL-6、IL-10水平分别为(19.31±2.11)、(8.66±3.74)、(4.27±1.16)μg/L,对照组患者血清TNF-α、IL-6、IL-10水平分别为(20.16±1.86)、(7.53±2.38)、(5.18±1.93)μg/L,2组比较差异均无统计学意义(P>0.05);术后1周,研究组患者血清TNF-α、IL-6、IL-10水平分别为(32.52±3.26)、(12.31±3.53)、(10.33±1.47)μg/L,明显低于对照组[(38.56±5.74)、(17.52±2.87)、(16.18±2.72)μg/L],差异均有统计学意义(t=13.181、12.968、13.382,P<0.05)。术后6个月,研究组患者的治疗有效率为96.0%(48/50),明显高于对照组[80.0%(40/50)],差异有统计学意义(χ^(2)=7.662,P<0.05)。结论应用PFNA内固定治疗老年股骨转子间骨折效果较理想,PFNA内固定具有创伤小、恢复快、能显著降低血清TNF-α、IL-6、IL-10水平的特点。
Objective To investigate the effect of proximal femur nail anti-rotation(PFNA)on the treatmeng of elderly patients with intertrochanteric femoral fracture,and to investigate the changes of tumer necrosis factor-α(TNF-α),interleukin-6(IL-6)and IL-10.Methods A total of 100 elderly patients with intertrochanteric femoral fracture who were treated in the Department of Traumatic Joint Surgery,Second Hospital of Qinhuangdao from August 2015 to May 2018 were selected as the research subjects.According to different treatment methods,they were divided into 2 groups:control group and study group,with 50 cases in each group.The control group received anatomic proximal femoral locking plate(APFLP)internal fixation.The patient took supine position under general anesthesia.All the locations from the base of the femoral neck to above the level of the lesser trochanter were exposed,and the displaced fracture was reduced.After the reduction was satisfactory,the anatomical plate and locking nail were fixed.The study group underwent PFNA internal fixation.The patient took supine position under general anesthesia.Under the fluoroscopy of C-arm machine,the appropriate PFNA main nail was selected.Under the fluoroscopy,the position of the proximal guide needle was satisfactory,and the guide needle was driven into the appropriate anti-rotation blade.At the distal end,a lock nail was screwed into through the sight.The changes of serum TNF-α,IL-6 and IL-10 levels in the 2 groups before and 1 week after surgery and the clinical therapeutic effect of the 2 groups 6 months after surgery were observed and compared.Data were processed with t test andχ^(2)test.Results The serum levels of TNF-α,IL-6 and IL-10 in the study group were(19.31±2.11),(8.66±3.74)and(4.27±1.16)μg/L before operation,respectively,and those in the control group were(20.16±1.86),(7.53±2.38)and(5.18±1.93)μg/L,respectively,there were no statistically significant differences between the 2 groups(P>0.05).One week after operation,the serum levels of TNF-α,IL-6 and IL-10 in the study group were(32.52±3.26),(12.31±3.53)and(10.33±1.47)μg/L,respectively,which were significantly lower than those in the control group[(38.56±5.74),(17.52±2.87)and(16.18±2.72)μg/L],there were statistically significant differences between the 2 groups(t=13.181,12.968,13.382;P<0.05).The effective rate in the study group 6 months after surgery was 96.0%(48/50),which was significantly higher than that in the control group[80.0%(40/50)],and the difference was statistically significant(χ^(2)=7.662,P<0.05).Conclusions The application of PFNA internal fixation in the treatmeng of elderly intertrochanteric femoral fracture has an ideal effect.PFNA internal fixation has the characteristics of small trauma,quick recovery,and can significantly reduce serum TNF-α,IL-6,IL-10 levels.
作者
白梅
王文强
蒙娜
Bai Mei;Wang Wenqiang;Meng Na(Departmet of Traumatic Joint Surgery,Second Hospital of Qinhuangdao,Qinhuangdao 066600,China)
出处
《中华损伤与修复杂志（电子版）》
CAS
2021年第1期28-33,共6页
Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)
基金
秦皇岛市科学技术研究与发展计划(201805A110)。
关键词
股骨
髋骨折
老年人
血清
防旋髓内钉
炎症因子
Femur
Hip fracture
Aged
Serum
Anti-rotation intramedullary nail
Inflammatory factor
作者简介
白梅,硕士研究生,主治医师。现就职于秦皇岛市第二医院创伤关节科。擅长创伤关节方向常见病、多发病的诊疗;通信作者:白梅,Email:baimei1208@sohu.com。
