肝功能不全对老年股骨粗隆间骨折手术结果的影响

Impact of liver dysfunction on the surgical outcome of intertrochanteric fractures in the elderly

[目的]探讨肝功能不全对老年股骨粗隆间骨折患者手术治疗效果的影响。[方法]回顾性分析本院2015年1月一2019年1月采用闭合复位InterTan髓内固定老年股骨粗隆间骨折52例患者的临床资料,根据术前肝功能Child-Turcotte分级,肝功正常22例,轻度肝损害(Child-Turcotte分级A级)19例,中度肝损害Child-Turcotte分级B级)11例。比较三组围手术期、随访与影像资料。[结果]三组手术时间差异无统计学意义(P>0.05),但术中出血量、切口愈合、住院时间、住院费用方面优劣顺序依次为:肝功正常组>轻度损害组>中度损害组,差异有统计学意义(P<0.05)。随访12~18个月。下地行走时间、完全负重活动时间、末次随访Harris评分和髋伸屈ROM的优劣依次为肝功正常组>轻度损害组>中度损害组,差异有统计学意义(P<0.05)。影像方面,三组间颈干角的差异均无统计学意义(P>0.05)。骨折愈合时间和内固定物影像表现的优势顺序依次为肝功正常组>轻度损害组>中度损害组,差异有统计学意义(P<0.05)。[结论]肝功能不全显著影响闭合复位Inter Tan髓内固定治疗老年股骨粗隆间骨折的临床效果。

[Objective]To explore the impact of liver dysfunction on surgical consequences of femoral intertrochanteric fractures in the elderly.[Methods]A retrospective study was conducted on 52 elderly patients who underwent closed reduction and internal fixation with InterTan intramedullary nail for femoral intertrochanteric fractures in our hospital from January 2015 to January 2019.According to the Child-Turcotte classification of preoperative liver function,22 patients had normal liver function,19 patients suffered from mild liver dysfunction(Grade A),and 11 patients were of moderate liver dysfunction(Grade B).The perioperative,follow-up and radiographic documents were compared among the three groups.[Results]Although there was no statistically significant difference in the operation time among the three groups(P>0.05),the orders from superiority to inferiority in terms of intraoperative blood loss,incision healing,hospitalization time,and hospitalization costs were the normal group>the mild impaired group>the moderate impaired group,which all were statisti-cally significant(P<0.05).Follow up period lasted for 12〜18 months.The ranks from excellent to poor in terms of returning walking and full weight-bearing activity,as well as Harris score and hip extension-flexion ROM at the latest follow-up were of the normal group>the mild impaired group>the moderate impaired group,with statistically significant differences(P<0.05).In term of radiographic evaluation,there was no statistically significant difference in the femoral neck-shaft angle among the three groups(P>0.05).However,the sequence in the order of superior-inferior regarding to fracture healing and manifestations of internal fixation on radiographs was the normal group>the mild impaired group>the moderate impaired group,which proved statistically significant(P<0.05).[Conclusion]Hepatic insufficiency significantly affects the clinical results of closed reduction and internal fixation with InterTan intramedullary nail for femoral intertrochanteric fractures in the elderly.