股骨近端防旋髓内钉与动力髋螺钉对不稳定型股骨粗隆间骨折患者SOD、AngⅡ的影响

Effects of PFNA and DHS on the levels of SOD and AngII in patients with unstable intertrochanteric fracture of femur using proximal femoral anti-rotation intramedullary nail and dynamic hip screw

目的探讨股骨近端防旋髓内钉(PFNA)与动力髋螺钉(DHS)对不稳定型股骨粗隆间骨折患者超氧化物歧化酶(SOD)、血管紧张素Ⅱ(AngⅡ)的影响。方法选取2017年7月至2018年6月创伤骨科择期手术治疗的90例不稳定型股骨粗隆间骨折患者,随机分为对照组和观察组,每组45例。对照组予以DHS治疗,观察组予以PFNA治疗。比较2组手术相关指标、关节功能恢复情况、应激水平及并发症发生情况、生活质量。结果观察组术后6个月疼痛评分、功能评分、行走能力评分、活动度评分、畸形评分和总分均显著高于对照组(P<0.05)。观察组并发症发生率为4.44%低于对照组的22.22%(P<0.05)。观察组手术时间、骨折愈合时间、术中出血量、开始负重时间均显著优于对照组(P<0.05)。术后2组患者去甲肾上腺素(NE)、SOD和AngⅡ水平均升高,观察组显著低于对照组(P<0.05)。观察组术后生存质量各维度评分均显著高于对照组,差异均有统计学意义(P<0.05)。结论PFNA较DHS对不稳定型股骨粗隆间骨折患者治疗效果更好,术后SOD和AngⅡ应激激素水平更低,髋关节功能恢复更好。

Objective To investigate the effects of proximal femoral anti-rotation intramedullary nail(PFNA)and dynamic hip screw(DHS)on the levels of superoxide dismutase(SOD)and angiotensinⅡ(AngⅡ)in patients with unstable intertrochanteric fracture of femur.Methods A total of 90 patients with unstable intertrochanteric fracture who were treated by surgery in our hospital from January to June 2018 were randomly divided into control group(n=45)and observation group(n=45).The patients in control group were treated by DHS,however,the patients in observation group were treated by PFNA.The operation related indexes,joint function recovery status,the stress levels,the incidence of complications and life quality of patients were observed and compared between the two groups.Results At 6 months after operation,the scores of pain,function,walking ability,mobility,deformity and total scores in observation group were significantly higher than those in control group(P<0.05).The incidence rate of complications in observation group was 4.44%,which was significantly lower than that(22.22%)in control group(P<0.05).Moreover the operation time,fracture healing time,intraoperative blood loss and time to start loading in observation group were significantly better than those in control group(P<0.05).After treatment,the levels of norepinephrine(NE),SOD and AngⅡin both groups were increased,which in observation group were significantly lower than those in control group(P<0.05).In addition the scores of all dimensions of postoperative life quality in observation group were significantly higher than those in control group(P<0.05).Conclusion The therapeutic effects of PFNA on unstable intertrochanteric fractures of femur are superior to those by DHS,with lower levels of SOD and AngⅡstress hormones and better recovery of hip joint function.