股骨颈骨折内固定去留对患者活动功能的影响

Effect of implant removal on physical function in femoral neck fracture patients after internal fixation

目的比较股骨颈骨折内固定去留对患者活动功能的影响。方法收集我院108例股骨颈骨折内固定术后患者临床资料,按照患者内固定术后是否行内固定取出术将患者分成取出组和对照组,其中取出组45例,对照组63例。比较两组患者骨折前、内固定取出前以及内固定取出后2年随访的一般临床资料以及简易12项量表(SF-12)评分和西安大略麦马斯特大学骨性关节炎指数可视化量表(WOMAC)评分。结果取出组患者年龄显著小于对照组(P<0.05),骨折移位、内固定松动发生率及可独立行走率显著高于对照组(P<0.05)。内固定取出前,取出组患者SF-12活动得分和总得分以及WOMAC疼痛得分、僵硬度得分、功能得分和总得分显著低于对照组患者(P<0.05)。内固定取出后,两组患者SF-12活动得分、心理得分和总得分以及WOMAC疼痛得分、僵硬度得分、功能得分和总得分差异无统计学意义(P>0.05)。内固定取出后对照组患者SF-12活动得分以及WOMAC疼痛得分、功能得分和总得分显著低于内固定取出前(P<0.05),取出组患者SF-12活动得分以及WOMAC疼痛得分、僵硬度得分、功能得分和总得分显著高于内固定取出前(P<0.05)。结论股骨颈骨折内固定术后手术部位持续疼痛及活动受限的患者内固定取出后可显著提高患者的活动功能,建议股骨颈骨折内固定术后手术部位有持续疼痛和活动受限的患者应考虑行内固定取出术。

Objective To explore the effect of implant removal on physical function in femoral neck fracture patients after internal fixation. Methods Clinical data of 108 femoral neck fracture patients after internal fixation were collected, and patients were divided into the removal group （u=45） and the control group （u=63）. General clinical data, 12-Item Short Form Survey （SF-12） scores and The West- ern Ontario and McMaster Universities Osteoarthritis Index （WOMAC） scores of two groups before fracture and before and 2 years after implant removal were compared. Results Compared to the control group, patients were younger, and the incidence of displaced fracture, implant loosening, and walking alone was higher in the removal group （P〈0.05）. Before implant removal, activity sub-score and total score in SF-12 and pain sub-score, stifness sub-score, function sub-score and total score in WOMAC were significantly lower in the removal group than that in the control group （P〈0.05）. After implant removal, there were no significant differences between two groups in activity sub-score, mentality subscore and total score in SF-12 and pain sub-score, stiflhess sub-score, function sub-score and total score in WOMAC （P〉0.05）. Moreover, activity sub-score in SF-12 and pain sub-score, function sub-score and total score in WOMAC were significantly lower in the control group after implant removal than that before implant removal （P〈0.05）. Activity sub-score and total score in SF-12 and pain sub-score, stiflhess.