不同手术治疗髋部骨折的疗效及对患者髋关节功能、骨代谢指标的影响

Efficacy of different surgical treatments on hip fracture and influence on hip joint function and bone metabolism index of patients

目的 比较不同手术治疗髋部骨折的疗效及对患者髋关节功能、骨代谢指标的影响。方法 采用随机数字表法将108例髋部骨折患者分为内固定组和置换组,各54例。内固定组以股骨近端髓内钉-螺旋刀片内固定治疗,置换组予以人工关节置换术治疗,2组术后均随访6个月。比较2组临床疗效、本体感觉平衡功能相关指标、骨代谢指标、髋关节功能、并发症。结果 术后6个月,置换组优良率高于内固定组(P <0.05);与术前比较,术后6个月2组血清骨钙素(BGP)、甲状旁腺激素(PTH)、骨碱性磷酸酶(BALP)水平、Harris髋部评分、髋部功能恢复量表(FRS)评分升高,置换组高于内固定组(P <0.05);2组Berg平衡量表评分升高,但置换组Berg平衡量表评分低于内固定组(P <0.05);置换组骨密度升高,且高于内固定组(P <0.05);随访期间,置换组总并发症发生率低于内固定组(P <0.05)。结论 股骨近端髓内钉-螺旋刀片内固定可改善髋部骨折患者平衡能力,但人工关节置换术可有效改善患者骨代谢指标,促进其髋关节功能恢复,降低并发症的发生,疗效相对更好。

Objective To compare the efficacy of different surgical treatments on hip fracture and the influence on hip joint function and bone metabolism index of patients.Methods 108 patients with hip fracture were divided into the internal fixation group and the replacement group according to random number table method,with 54 cases in each group.The internal fixation group was treated with proximal femoral intramedullary nail-spiral blade internal fixation,and the replacement group was treated with artificial joint replacement surgery.Both groups were followed up for 6 months after surgery.The clinical eficacy,proprioceptive balance function related indexes,bone metabolism indexes,hip joint function and complications were compared between two groups.Results At 6 months after operation,the excellent and good rate of the replacement group was higher than that of the internal fixation group(P<0.05).Compared with before operation,at 6 months after surgery,the levels of serum osteocalcin(BGP),parathyroid hormone(PTH)and bone alkaline phosphatase(BALP),and Harris hip score and hip function recovery scale(FRS)score in two groups increased,and the replacement group was higher than the internal fixation group(P<0.05);Scores of Berg balance scale increased in two groups,but Berg balance scale scores in the replacement group were lower than those in the internal fixation group(P<0.05);Bone mineral density in the replacement group increased and was higher than that in the internal fixation group(P<0.05).During follow-up,the total complication rate in the replacement group was lower than that in the internal fixation group(P<0.05).Conclusion Proximal femoral intramedullary nail-spiral blade internal fixation can improve the balance ability of patients with hip fracture.But artificial joint replacement surgery can effectively improve the bone metabolism indexes of patients,promote the recovery of hip joint function,reduce the occurrence of complications,and has relatively better therapeutic effects.