| 李逸群,吴 昊,向 奎.不同方法治疗老年股骨转子间不稳定骨折疗效对比[J].中国烧伤创疡杂志,2024,(3):232~236. |
| DOI： |
| 中文关键词: 股骨转子间骨折 不稳定骨折 老年 生物型加长柄关节置换 股骨近端防旋髓内钉内固定 |
| 英文关键词:Femoral intertrochanteric fracture Unstable fracture Elderly Cementless long-stem hip joint
replacement Proximal femoral nail antirotation internal fixation |
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| 中文摘要: |
| 【摘要】 目的 对比分析生物型加长柄关节置换与股骨近端防旋髓内钉内固定治疗老年股骨转子间不稳定骨折的临床效果。方法 选取 2019 年 6 月至 2021 年 6 月安阳市第三人民医院收治的 104 例老年股骨转子间不稳定骨折患者作为研究对象, 根据不同手术治疗方式将其分为置换组 (52 例) 和固定组 (52 例), 置换组患者采用生物型加长柄关节置换术治疗, 固定组患者采用股骨近端防旋髓内钉内固定术治疗, 对比观察两组患者围术期相关指标、髋关节恢复情况、生活质量及术后不良事件发生情况。结果 置换组患者术中出血量明显多于固定组、手术时间明显长于固定组 (t = 5.545、5.150, P 均<0.001), 而首次下床活动时间及住院时间与固定组无明显差异 (t = 1.933、1.619, P= 0.056、0.109)。术后 12 个月, 置换组患者髋关节恢复优良率为 80.77%, 明显高于固定组患者的髋关节恢复优良率 61.54% (χ2 = 4.685, P= 0.030); 置换组患者健康调查量表 36 ( SF-36) 中的躯体功能、躯体疼痛、总体健康、生理功能评分均明显高于固定组 ( t = 3.062、2.868、3.028、3.440, P =0.003、0.005、0.003、0.001)。置换组患者术后不良事件发生率为 5.77%, 明显低于固定组患者的术后不良事件发生率 21.15% (χ2 = 5.283, P= 0.022)。结论 与股骨近端防旋髓内钉内固定相比, 生物型加长柄关节置换虽会增加老年股骨转子间不稳定骨折患者术中出血量, 延长手术时间, 但能够提高患者髋关节功能及生活质量,降低不良事件发生风险, 临床效果更佳。 |
| 英文摘要: |
| 【Abstract】 Objective To compare the clinical efficacy of cementless long?stem hip joint replacement and proximal femoral nail antirotation internal fixation in the treatment of unstable femoral intertrochanteric fractures in the elderly. Methods 104 elderly patients with unstable femoral intertrochanteric fractures admitted to Anyang Third People’s Hospital from June 2019 to June 2021 were enrolled as the research subjects, and divided into replacement group (n = 52) and fixation group (n = 52) based on the different treatments they received. Patients in the replacement group were treated with cementless long-stem hip joint replacement, whereas patients in the fixation group were treated with proximal femoral nail antirotation internal fixation. The perioperative related indicators, recovery condition of hip joint, quality of life and occurrence of adverse reactions after surgery were compared between the two groups. Results The intraoperative blood loss of patients in the replacement group was significantly more than that in the fixation group, and the operation duration was significantly longer in the replacement group (t = 5.545 and 5.150, both P<0.001), while there were no significant differences between the two groups in terms of the first off?bed ambulation time and the length of stay (t = 1.933 and 1.619, P=0.056 and 0.109). At 12 months after surgery, the good and excellent rate of hip function recovery was 80.77% in the replacement group, which was significantly higher than the corresponding 61.54% in the fixation group ( χ2 = 4.685, P =0.030), the scores of the patients evaluated using the 36-item short form health survey (SF-36) including physical functioning, bodily pain, general health, and physiological function were significantly higher in the replacement group compared with the fixation group (t = 3.062, 2.868, 3.028 and 3.440, P= 0.003, 0.005, 0.003 and 0.001), and the incidence of postoperative adverse reactions of patients was 5.77% in the replacement group, being much lower than 21.15% in the fixation group (χ2 = 5.283, P = 0.022). Conclusion Compared with proximal femoral nail antirotation internal fixation, cementless long-stem hip joint replacement, in the treatment of elderly unstable femoral intertrochanteric fractures, is superior in ameliorating hip joint function and patients’ quality of life, and decreasing the occurrence risk of postoperative adverse reactions, though might lead to more intraoperative blood loss and longer operation time, achieving better clinical efficacy. |
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