不同手术方式对移位性股骨颈骨折患者髋关节活动度、免疫炎性反应及凝血-纤溶系统的影响

Effects of different surgical methods on hip joint range of motion,immune inflammatory response and coagulation-fibrinolysis system in patients with displaced femoral neck fracture

目的探讨不同手术方式对移位性股骨颈骨折患者髋关节活动度、免疫炎性反应及凝血-纤溶系统的影响。方法前瞻性选择移位性股骨颈骨折患者92例,根据治疗方案分为全髋关节置换术(total hip arthroplasty,THA)组48例和人工股骨头置换术(hemiarthroplasty,HA)组44例。比较2组围手术期指标、术后并发症发生率、手术疗效、总费用、日常生活功能恢复量表(functional recovery scale,FRS)评分、成本效果比(cost-effectiveness ratio,CER)、手术前后髋关节活动度评分、免疫炎性指标[白细胞介素6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素1β(interleukin-1β,IL-1β)]及凝血-纤溶系统指标[白陶土部分凝血活酶时间(kaolin partial thromboplastin time,KPTT)、凝血酶原时间(prothrombin time,PT)、组织型纤溶酶原激活物抑制剂(plasminogen activator inhibitor,PAI)、D二聚体(D-Dimer,D-D)]。结果THA组手术时间、术中出血量、住院时间长于或多于HA组(P<0.05);2组髋关节活动度评分均呈升高趋势,THA组髋关节活动度评分均高于HA组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05);THA组手术优良率高于HA组,术后并发症发生率低于HA组(P<0.05);2组IL-6、TNF-α、IL-1β、KPTT、PT、PAI、D-D水平均呈先升高后降低趋势,THA组IL-6、TNF-α、IL-1β、KPTT、PT、PAI、D-D水平高于HA组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05);THA组总费用和2年内CER高于HA组(P<0.05)。2组FRS评分差异无统计学意义(P>0.05)。结论与HA相比,THA治疗移位性股骨颈骨折患者虽然手术创伤较大,总体费用较高,但患者髋部功能改善更加明显,若患者年龄、预期寿命、身体情况及经济条件允许,建议行THA治疗。

Objective To investigate the effects of different surgical methods on hip joint range of motion(ROM),immune inflammatory response and coagulation-fibrinolysis system in patients with displaced femoral neck fractures.Methods A total of 92 patients with displaced femoral neck fractures in our hospital were prospectively selected as the research subjects and were divided intototal hip arthroplasty(THA)group(n=48)and hemiarthroplasty(HA)group(n=44).The perioperative indicators,postoperative complication rate,surgical efficacy,total cost,functional recovery scale(FRS)score and cost-effectiveness ratio(CER),hip joint ROM score before and after surgery,immune inflammatory indexes[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)],coagulation-fibrinolytic system indicators[kaolin partial thromboplastin time(KPTT),prothrombin time(PT),plasminogen activator inhibitor(PAI),D-dimer(D-D)]before and after surgery were statistically compared between two groups.Results The duration of operation,intraoperative blood loss and length of hospital stay in THA group were longer or more than those in HA group(P<0.05).The scores of hip joint ROM were increased,and the scores were higher in THA group than in HA group.There was significant difference in the interaction between groups,time points and time points between groups(P<0.05).The excellent and good rate of THA group was higher than that of HA group,while the incidence of postoperative complications was lower than that of HA group(P<0.05).The levels of IL-6,TNF-α,IL-1β,KPTT,PT,PAI and D-D increased initially and then decreased in both groups,which were higher in THA group than in HA group;there were significant differences in the interaction between groups,time points and time points between groups(P<0.05).The total cost and CER within 2 years in THA group were higher than those in HA group(P<0.05).There was no significant difference in FRS score between two groups(P>0.05).Conclusion Compared with HA,the application of THA in the treatment of patients with displaced femoral neck fractures has greater surgical trauma and higher overall costs,but the hip function is improved more significantly.If the patient′s age,life expectancy,physical condition and economic conditions are appropriate,THA is recommended.