摘要
目的探讨股骨近端防旋髓内钉内固定(PFNA)手术治疗老年股骨转子间骨折的效果及对髋关节功能的影响。方法回顾性分析2018年4月到2022年4月在河南省人民医院接受治疗的68例老年股骨转子间骨折患者的临床资料,根据治疗方法分为对照组和研究组。对照组患者采用人工髋关节置换术,研究组采用PFNA手术。比较两组患者临床疗效、手术相关指标、髋关节功能及并发症、血凝指标的变化。组间计量数据比较采用t检验。结果对照组患者手术切口[(10.04±1.84)cm]明显高于研究组患者手术切口[(4.62±0.82)cm],差异有统计学意义(t=15.720,P<0.05)。对照组患者手术时间[(52.56±5.93)min]明显高于研究组患者[(41.35±8.54)min],差异有统计学意义(t=6.284,P<0.05)。对照组患者术中出血量[(238.21±19.54)ml]明显高于研究组患者[(181.91±18.91)ml],差异有统计学意义(t=12.070,P<0.05)。对照组患者透视次数[(238.21±19.54)次]明显高于研究组患者[(181.91±18.91)次],差异有统计学意义(t=4.778,P<0.05)。对照组患者下床活动时间[(19.18±2.21)d]明显高于研究组患者[(8.26±2.08)d],差异有统计学意义(t=20.980,P<0.05)。对照组患者术后1、3和6个月Haris评分[(59.65±5.00)、(74.85±3.19)、(83.32±4.02)分]明显低于对照组患者[(68.06±4.27)、(82.94±3.00)、(93.92±3.75)分],差异有统计学意义(t=7.457、10.760、11.230,P<0.05)。对照组患者术后并发生发生率(6/34)明显高于研究组(1/34),差异有统计学意义(χ^(2)=12.430,P<0.05)。观察组患者术后7 d PT水平[(15.56±2.13)s]明显高于研究组患者[(12.35±1.81)s],差异有统计学意义(t=3.700,P<0.05)。观察组患者术后7 d APTT和D-二聚体[(29.44±2.68)s、(0.32±0.04)mg/L]明显低于研究组患者[(32.50±4.01)s、(0.52±0.05)mg/L],差异有统计学意义(t=6.684、17.840,P<0.05)。结论PFNA可以减少术中出血量、缩短手术时间,改善髋关节功能,降低术后并发症发生。
Objective To investigate the effect of proximal femoral antirotation nail internal fixation(PFNA)in the treatment of femoral intertrochanteric fracture in the elderly and its effect on hip function.Methods The clinical data of 68 elderly patients with intertrochanteric fracture of femur treated in our hospital from April 2018 to April 2022 were retrospectively analyzed.They were divided into control group and study group according to the treatment method.The patients in the control group were treated with artificial hip replacement,and the patients in the study group were treated with PFNA.The changes of clinical efficacy,operation related indexes,hip joint function and complications,and coagulation indexes were compared between the two groups.T-test was used to compare the measurement data between groups.Results The surgical incision in the control group[(10.04±1.84)cm]was significantly higher than that in the study group[(4.62±0.82)cm,t=15.720,P<0.05].The operation time of patients in the control group[(52.56±5.93)cm]was significantly higher than that of patients in the study group[(41.35±8.54)cm,t=6.284,P<0.05].The amount of intraoperative bleeding in the control group[(238.21±19.54)ml]was significantly higher than that in the study group[(181.91±18.91)ml,t=12.070,P<0.05].The number of fluoroscopy in the control group[(238.21±19.54)times]was significantly higher than that in the study group[(181.91±18.91)times,t=4.778,P<0.05].The ambulation time of patients in the control group[(19.18±2.21)d]was significantly higher than that of patients in the study group[(8.26±2.08)d,t=20.980,P<0.05].The Haris score(59.65±5.00,74.85±3.19,83.32±4.02)in the control group at 1 month,3 months and 6 months after operation was significantly lower than that in the control group(68.06±4.27,82.94±3.00,93.92±3.75,t=7.457,10.760,11.230,P<0.05).The incidence of postoperative complications in the control group(6/34)was significantly higher than that in the study group(1/34)(χ^(2)=12.430,P<0.05).The PT level of patients in the observation group[(15.56±2.13)s]was significantly higher than that of patients in the study group[(12.35±1.81)s]after operation7 days(t=3.700,P<0.05).APTT and D-dimer[(29.44±2.68)s,(0.32±0.04)mg/L]in the observation group were significantly lower than those in the study group[(32.50±4.01)s,(0.52±0.05)mg/L]after operation7 days(t=6.684,17.840,P<0.05).Conclusion PFNA can reduce intraoperative bleeding,shorten the operation time,improve hip function and reduce postoperative complications.
作者
蔡腾
彭强
王冰一
刘涛
Cai Teng;Peng Qiang;Wang Bingyi;Liu Tao(Department of Traumatic Orthopedics,Henan Provincial People′s Hospital,Zhengzhou University People′s Hospital,Zhengzhou 450003,China)
出处
《中华实验外科杂志》
CAS
北大核心
2022年第10期2018-2021,共4页
Chinese Journal of Experimental Surgery
基金
河南省医学科技攻关计划项目(SB201901081)。
关键词
股骨近端防旋髓内钉内固定
股骨转子间骨折
髋关节功能
并发症
凝血指标
Proximal femoral antirotation nail internal fixation
Intertrochanteric fracture of femur
Hip function
Complication
Coagulation index
作者简介
通信作者:刘涛,Email:liutaogk@163.com。
