人工股骨头置换在高龄股骨转子间骨折中的应用及对髋关节功能的影响

Application of artificial femoral head replacement in elderly patients with intertrochanteric fracture and its influence on hip joint function

目的探讨人工股骨头置换在高龄股骨转子间骨折中的应用及对髋关节功能的影响。方法选取2014年6月~2015年6月榆林市第一医院就诊的80例高龄股骨转子间骨折患者为研究对象,按随机数表法分为观察组(n=40)和对照组(n=40),对照组采用PFNA内固定治疗,观察组采用人工股骨头置换术治疗。观察两组治疗优良率、手术时间、术中失血量、卧床休息时间、住院时间,视觉模拟评分法(VAS)、髋关节功能评分(Harris),神经生长因子(NGF)、白细胞介素-6(IL-6),硬骨素(Sclerostin)、Ⅰ型胶原C端肽(CTX)、骨保护素(OPG)水平,不良反应发生率及疗效。结果治疗后,观察组优良率明显高于对照组(P<0.05);手术时间、术中失血量、卧床休息时间及住院时间比较,观察组均明显低于对照组(均P<0.05);观察组VAS评分明显低于对照组(P<0.05),而Harris评分明显高于对照组(P<0.05);两组NGF水平均明显升高,且观察组明显高于对照组(均P<0.05);两组Sclerostin水平较治疗前均升高,且观察组明显高于对照组(均P<0.05),而CTX、OPG水平,观察组低于对照组(P<0.05);观察组不良反应总发生率明显低于对照组(P<0.05)。结论人工股骨头置换可快速恢复患者髋关节功能,有效改善血清Sclerostin、CTX、OPG、NGF水平,减少并发症,缓解疼痛,可促进早期患肢锻炼,对于治疗高龄股骨转子间骨折可达到满意疗效。

ObjectiveTo study application of artificial femoral head replacement in elderly patients with intertrochanteric fracture and its influence on hip joint function. Methods80 elderly patients of intertrochanteric fracture received therapy from June 2014 to June 2015 in our hospital were selected as research objects. According to random number table, they were divided into the Observation group ( n =40) and the control group ( n =40). The control group was treated with PFNA internal fixation, while the Observation group was treated with artificial femoral head replacement. The operation time, intraoperative blood loss, bed rest time, hospitalization time, Visual Analogue Scale/Score(VAS), Hip function score (Harris), Nerve growth factor (NGF) and interleukin-6 (IL-6), Osteosin (Sclerostin), type I collagen C terminal peptide (CTX) and osteoprotegerin (OPG), adverse reaction rate, treatment effect in two groups were compared. ResultsThe excellent and good rate of treatment was significantly higher than that of the control group( P <0.05). The operation time, intraoperative blood loss, bed rest time and hospital stay in the observation group were significantly lower than that of the control group. The VAS score was significantly lower than that of the control group( P <0.05). The Harris score of the observation group was significantly higher than that of the control group( P <0.05). There was no significant difference in the level of IL-6 between the two groups( P >0.05). The level of NGF was significantly higher than that of the control group( P <0.05). The level of Sclerostin was significantly higher than that of the control group( P <0.05). The level of CTX,OPG was significantly lower than the control group ( P <0.05). The incidence of adverse reactions was significantly lower than that of the control group( P <0.05). ConclusionArtificial femoral head replacement can quickly restore the patient's hip function. It can effectively improve the level of serum Sclerostin, CTX, OPG and NGF, reduce complications, relieve pain and promote early limb exercise.