股骨粗隆间骨折术后早期负重在适宜人群中的效果

Effect of EarlyWeight-bearing on Appropriate Population with Intertrochanteric Fracture after Surgery

目的观察股骨粗隆间骨折术后早期负重在适宜人群中的康复疗效。方法2017年4月至2018年12月,本院骨科Evans-JensenⅡ型股骨粗隆间骨折行股骨近端防旋髓内钉(PFNA)内固定术后,且骨折复位符合股内侧皮质阳性支撑(PMCS)的患者45例随机分成对照组(n=22)和试验组(n=23)。对照组于术后6周行耐受性负重,试验组于术后48 h内行耐受性负重,均由每次10 min、每天3次逐渐递增至每次20 min、每天5次,直到骨折临床愈合。比较两组的住院时间、住院费用、骨折临床愈合时间和并发症,术后6周、3个月、6个月比较疼痛视觉模拟评分(VAS)和Harris髋关节评分。结果试验组住院时间明显短于对照组(t=3.716,P<0.01);住院费用低于对照组,但无显著性差异(t=1.540,P>0.05);骨折临床愈合时间显著短于对照组(t=6.248,P<0.001)。试验组并发症发生率低于对照组,但无显著性差异(χ2=2.198,P>0.05)。术后6周、3个月和6个月,两组VAS均无显著性差异(t<1.330,P>0.05)。试验组术后6周Harris髋关节评分显著高于对照组(t=-5.115,P<0.001),两组术后3个月和6个月无显著性差异(|t|<1.799,P>0.05)。结论Ⅱ型股骨粗隆间骨折PFNA内固定术后,且骨折复位符合PMCS的患者于术后48 h内行耐受性负重可减少住院时间,促进骨折愈合和早期髋关节功能的康复。

Objective To observe the effect of early weight-bearing on the appropriate population with intertrochanteric fracture after surgery.Methods From April, 2017 to December, 2018, a total of 45 patients with Evans-Jensen type Ⅱ intertrochanteric fracture and fracture reduction as positive medial cortex support(PMCS) after proximal femoral nail anti-rotation(PFNA) fixation were randomly divided into control group(n = 22) and experimental group(n = 23). Weight-bearing as tolerated(WBAT) was initiated from six weeks after surgery in the control group, and within 48 h after surgery in the experimental group. The frequency of WBAT in two groups increased gradually from three times a day for ten minutes a time to five times a day for 20 minutes a time until clinical healing of fracture. The length of stay, hospital cost, the fracture healing time and the complication incidence were compared between two groups, as well as the scores of Visual Analogue Scale(VAS) and Harris Hip Score at six weeks, three months and six months after surgery.Results Compared with the control group, the length of stay was shorter(t = 3.716, P < 0.01), the hospital cost was lower, but no significant difference was found(t = 1.540, P > 0.05), and the fracture healing time was shorter(t =6.248, P < 0.001) in the experimental group. The complication incidence was lower in the experimental group,but there was no significant difference(χ~2= 2.198, P > 0.05). Six weeks, three months and six months after surgery, there was no significant difference in the score of VAS between two groups(t < 1.330, P > 0.05). The score of Harris Hip Score was significantly higher in the experimental group than in the control group six weeks after surgery(t =-5.115, P < 0.001), however, no significant difference was found in other time points(|t| < 1.799,P > 0.05).Conclusion Early weight-bearing within 48 h after PFNA fixation for Evans-Jensen type II intertrochanteric fractures and reduction with PMCS could shorten the length of stay, shorten the bony healing time and promote early recovery of hip function.