骨水泥型与生物型假体半髋置换治疗老年股骨颈骨折的创伤程度及骨代谢比较

Comparison of the effect of bone cemented and biological prostheses hemiarthroplasty on postoperative trauma and bone metabolism of elderly patients with femoral neck fracture

目的探讨骨水泥型与生物型假体半髋置换对老年股骨颈骨折患者术后创伤程度及骨代谢的影响。方法选取2018年1月至2020年1月本院行半髋置换的老年股骨颈骨折患者60例,按假体类型分为骨水泥型组和生物型组各30例,对比2组患者术前、术后第1、7 d的炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、降钙素原(PCT)、C-反应蛋白(CRP)]、应激激素[去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)]、骨代谢标志物[Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、总Ⅰ型胶原氨基端延长肽(tPINP)、骨碱性磷酸酶(BALP)、全段甲状旁腺素(iPTH)]水平。结果2组患者术前、术后第1、7 d炎症因子(TNF-α、IL-6、PCT、CRP)、骨代谢(β-CTX、tPINP、BALP、iPTH)水平比较差异均无统计学意义(P>0.05)。2组患者应激激素(NE、E、COR)水平术前、术后第7天比较差异无统计学意义(P>0.05),术后第1天比较差异有统计学意义(P<0.05)。结论两种假体手术对老年股骨颈骨折患者的炎症因子、骨代谢影响无差异,但生物型假体对患者的应激激素影响小,对基础病多手术耐受性差者更具优势。

Objective To investigate the effect of bone cemented and biological prostheses hemiarthroplasty on postoperative trauma and bone metabolism in the elderly patients with femoral neck fracture.Methods 60 elderly patients with femoral neck fracture who have underwent hemiarthroplasty in our hospital from January 2018 to January 2020 were selected and divided into cemented type group and biological type group with 30 cases each according to prosthesis type.The levels of inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),procalcitonin(PCT),C-reactive protein(CRP)],stress hormones[norepinephrine(NE),epinephrine(E),cortisol(Cor)],bone metabolic markers[type I collagen carboxy-terminal peptideβspecial sequence(β-CTX),total type I collagen amino-terminal elongation peptide(tPINP),bone alkaline phosphatase(BALP),whole-segment parathyroid hormone(iPTH)]were compared between the two groups on preoperative and the 1st and 7th day after operation.Results The levels of inflammatory factors(TNF-α,IL-6,PCT,CRP)and bone metabolism(β-CTX,tPINP,BALP,iPTH)were not statistical significance between the two groups(P>0.05)on preoperative and the 1st and 7th day after operation.The levels of stress hormone(NE,E,COR)between the two groups were not statistical significance on preoperative and the 7th day after operation(P>0.05),but on the 1st day after operation(P<0.05).Conclusion There is no difference in inflammatory factors and bone metabolism between the two prosthesis surgeries for elderly patients with femoral neck fracture.However,biological prostheses have little effect on stress hormone and have more advantages for patients with many basic diseases and poor surgical tolerance.