术前慢性病对高龄股骨粗隆间骨折手术患者疗效的影响

Effect of preoperative chronic disease on the fixation of intertrochanteric femoral fracture

目的探讨术前慢性病对股骨近端髓内钉(PFN)内固定治疗老年股骨粗隆间骨折疗效的影响。方法回顾性分析我院2008年1月至2013年5月收治的诊断为股骨粗隆间骨折并采用PFN内固定治疗的286例高龄患者的临床资料,根据术前是否有慢性病将其分为两组,A组96例,术前无慢性病,B组190例,术前患有慢性病,比较两组患者的围手术期失血量、术后3、6、12个月术侧髋关节Harris评分及术后并发症发生情况。结果 B组患者围手术期失血总量、显性失血量、隐性失血量均高于A组(P<0.05);A组在术后3个月、6个月、12个月的Harris髋关节功能评分均明显高于B组(P<0.05),术后并发症发生率B组明显高于A组(P<0.05)。结论术前合并慢性病会对股骨PFN内固定治疗老年股骨粗隆间骨折疗效造成影响,因此术前合并慢性病者要综合评估,加强处理,积极治疗可预防并发症的发生。

Objective To investigate and evaluate the effect of preoperative chronic disease on internal fixation with proximal femoral nails（PFN） in the treatment of elderly intertrochanteric femoral fracture. Methods A retrospective analysis of 286 elderly patients diagnosed as intertrochanteric femoral fractures and treated with PFN in our hospital from January 2008 to May 2013 was conducted, which were divided into two groups according to the presence of preoperative chronic disease. Patients of group A（n=96） did not had preoperative chronic disease,while patients of group B（n=190） had preoperative chronic disease group. The blood loss during the operation,hip Harris score and postoperative complications 3, 6, 12 months after the operation were compared between the two groups. Results The total blood loss, dominant blood loss, hidden blood loss and the operation period of patients in group B were significantly higher than those in group A（P〈0.05）. Harris hip joint function 3 months, 6 months, 12 months after operation of group A were significantly higher than those of group B（P〈0.05）, and the occurrence rate of postoperative complications in group B was significantly higher than that in group A. Conclusion Preoperative chronic disease can influence the curative effect of PFN internal fixation in treatment of intertrochanteric femoral fractures. Therefore, patients with preoperative chronic diseases should be comprehensively assessed and actively treated to prevent complications.