股骨偏心距改变对老年股骨转子间骨折术后功能影响

Effect of Femoral Offset Change on the Postoperative Function of Intertrochanteric Fracture in Elderly People

目的探讨老年股骨转子间骨折术后股骨偏心距的改变对关节疼痛和功能的影响。方法以2017年9月至2019年6月行单侧股骨转子间骨折闭合复位内固定术且符合筛选标准共96例患者为研究对象,根据术后患侧与健侧偏心距的差值分为3组,其中34例术后患侧偏心距较健侧小5 mm(减小组),32例术后患侧偏心距与健侧差值在-5~5 mm之间(正常组),30例术后患侧偏心距较健侧大5 mm(增大组)。减小组34例患者,男14例,女20例;平均年龄(77.47±8.12)岁;稳定性骨折19例,不稳定性骨折15例;ASAⅡ级9例,ASAⅢ级25例。正常组32例患者,男13例,女19例;平均年龄(80.09±7.17)岁;稳定性骨折20例,不稳定性骨折12例;ASAⅡ级8位,ASAⅢ级24位。增大组30例患者,男9例,女21例;平均年龄为(81.00±7.63)岁;稳定性骨折20例,不稳定性骨折10例;ASAⅡ级6位,ASAⅢ级24位。根据Harris评分评定3组术后3个月、术后6个月、术后1年的临床疗效。结果3组患者年龄、性别、骨折类型、美国医师麻醉协会(American society of anesthesiologists,ASA)分级、术后血红蛋白一般资料比较差异无统计学意义(P>0.05)。减小组术后3个月、术后6个月Harris评分较正常组及增大组高,差异有统计学意义(P<0.05),术后1年Harris评分结果显示正常组和减小组差异无统计学意义(P>0.05),术后3个月、6个月、1年增大组评分较正常组及减小组低,差异均有统计学意义(P<0.05)。结论股骨偏心距影响股骨转子间骨折患者的术后功能。术后偏心距减小可以促进股骨转子间骨折患者的早期康复,减轻疼痛,改善生活质量。术后偏心距增大会延缓患者的康复,术后关节功能评分较低。

Objective To investigate the effects of altering the femoral offset on the postoperative function of femoral trochanteric fracture in elderly people.Methods A total of 96 patients undergoing single femoral trochanteric fracture closed and internal fixation between September 2017 and June 2019 met the inclusion criteria.According to difference of femoral offset between operative side and contralateral side,the patients were divided into 3 groups:decreased offset group(<-5 mm,34 cases),normal offset group(-5~5 mm,32 cases),and increased offset group(>5 mm,30 cases).The reduction group had 34 patients inincluding 14 males and 20 females.The average age was(77.47±8.12)years old.There were 19 stable fractures and 15 unstable fractures.Among them,there were 9 ASAⅡlevel and 25 ASAⅢlevel.T the normal group had 32 patients,including 13 males and 19 females.The average age was(80.09±7.17)years old.There were 20 stable fractures and 12 unstable fractures.Among them,there were 8 ASA levelⅡ,24 ASA levelⅢ.The enlarged group had 30 patients,including 9 males and 21 females.The average age was(81.00±7.63)years old.There were 20 stable fractures and 10 unstable fractures.Among them,there were 6 ASA levelⅡ,24 ASA levelⅢ.Clinical efficacy was evaluated by Harris score 3 months,6 months and 1 year after surgery.Results There were no statistically significant differences in age,gender,fracture type,ASA grading and postoperative hemoglobin among the three groups(P>0.05).3 months and 6 months after surgery Harris score in the decrease group was higher than that in the normal group and the increase group,and the difference was statistically significant(P<0.05).Harris score 1 year after surgery showed no statistically significant difference between the normal group and the decrease group(P>0.05),The scores of the increased group at 3 months,6 months and 1 year after surgery were lower than those of the normal group and the decreased group,with statistically significant differences(P<0.05).Conclusion Femoral offset affects postoperative function of patients with intertrochanteric fracture.Postoperative offset decrease can promote early recovery of femoral trochanteric fracture,reduce pain,and improve the quality of life.Postoperative offset increase will delay the recovery of patients,postoperative joint function score is lower.