ERAS联合微创内固定治疗老年稳定型股骨转子间骨折疗效分析

Analysis of the efficacy of ERAS combined with minimally invasive internal fixation in the treatment of senile stable intertrochanteric fracture

目的探讨老年稳定型股骨转子间骨折加速康复外科(ERAS)联合微创内固定治疗效果。方法将2015年8月至2018年8月老年稳定型股骨转子间骨折患者72例分为两组。在ERAS方案下分别行经皮加压钢板(PCCP)及股骨近端抗旋髓内钉(PFNA)内固定治疗,比较两组术中出血量、手术时间及完全负重时间,术后3个月患者满意度、术后1年死亡率及并发症发生率。结果两组72例患者获12~24个月(平均16个月)随访,术中出血量:PCCP组(51.67±18.16)ml、PFNA组(46.31±16.57)ml;手术时间:PCCP组(51.03±13.74)min、PFNA组(45.48±12.28)min,两组比较差异无统计学意义(P>0.05)。完全负重时间:PCCP组(13.00±3.01)周、PFNA组(9.86±2.81)周,两组比较差异有统计学意义(P<0.05)。两组术后1年死亡率比较差异无统计学意义(P>0.05),术后3个月患者满意度及并发症发生率比较差异有统计学意义(P<0.05)。结论ERAS联合两种内固定方法治疗稳定型老年股骨转子间骨折均取得良好的效果,但严重骨质疏松患者建议行髓内固定。

Objective To explore the effect of enhanced recovery after surgery(ERAS)combined with minimally invasive internal fixation for senile stable intertrochanteric fracture of femur.Methods 72 elderly patients with stable intertrochanteric fracture of femur between August 2015 and August 2018 were divided into two groups.Patients were treated with PCCP and PFNA internal fixation respectively under ERAS plan.And blood loss,operation time,and total weight-bearing time were compared between the two groups,patients'satisfaction at 3 months after operation,mortality at 1 year after operation,and the incidence of complications were compared.Results 72 patients in the two groups were followed up for 12 to 24 months(average 16 months).There were no statistically significant differences in intraoperative blood loss[PCCP group:(51.67±18.16)ml,PFNA group:(46.31±16.57)ml]and operation time[PCCP group:(51.03±13.74)min,PFNA group:(45.48±12.28)min]between the two groups(P>0.05);there was statistically significant difference in total weight-bearing time[PCCP group:(13.00±3.01)w,PFNA group:(9.86±2.81)w]between the two groups(P<0.05).There was no statistically significant difference in postoperative 1 year mortality between the two groups(P>0.05),there were statistically significant differences in patient satisfaction at 3 months after surgery and the incidence of complications(P<0.05).Conclusion ERAS combined with two internal fixation methods have achieved good results in the treatment of stable intertrochanteric fractures in the elderly,but intramedullary fixation is recommended in patients with severe osteoporosis.