人工关节置换术治疗老年髋臼骨折疗效及对患者血清炎性指标、骨代谢水平的影响

Effect of artificial joint replacement on serum inflammatory indexes and bone metabolism in elderly patients with acetabular fractures

目的:探究人工关节置换术治疗老年髋臼骨折疗效及对患者血清炎性指标以及骨代谢水平的影响。方法:选取120例老年髋臼骨折患者作为研究对象,将患者按照随机数表法分为观察组(60例)和对照组(60例)。对照组患者进行内固定术治疗,观察组患者进行人工关节置换术治疗。①比较两组患者手术时间、术中出血量、术中及术后输血量、术后引流量以及住院时间等情况;②采用Harris评分对两组患者术前以及术后3个月髋关节功能进行评估;③比较两组患者术前术后体内血清炎症因子白细胞介素6(IL-6)、C反应蛋白(CRP)以及血清降钙素原(PCT)含量;④比较两组患者术前术后体内骨密度(BMD)水平以及血清骨钙素(OC)、甲状旁腺激素(PTH)、骨碱性磷酸酶(BALP)等骨代谢水平;⑤比较两组患者切口感染、下肢静脉炎、创伤性骨关节炎以及坐骨神经损伤等不良反应的发生情况。结果:①观察组患者的手术时间以及术中出血量均明显高于对照组患者,下地负重时间以及住院时间均明显少于对照组患者,且组间比较差异具有统计学意义(均P<0.05);②术前对照组与观察组髋关节功能评分比较差异无统计学意义(P>0.05);术后3个月观察组患者髋关节功能评分高于对照组,且组间比较差异具有统计学意义(P<0.05);③术前对照组与观察组患者体内血清炎性因子水平比较差异无统计学意义(P>0.05);术后观察组患者体内血清炎性因子水平低于对照组,且组间差异具有统计学意义(P<0.05);④术前对照组与观察组患者体内OC、PTH、BALP以及BMD水平比较差异无统计学意义(均P>0.05);术后两组患者体内OC、PTH、BALP以及BMD水平均有改善,观察组患者OC、PTH、BALP以及BMD水平均高于对照组,且组间比较差异具有统计学意义(均P<0.05);⑤与对照组患者相比,观察组患者切口感染、下肢静脉炎、创伤性骨关节炎以及坐骨神经损伤等不良反应例数均有减少,不良反应的总体发生率有明显降低,且组间比较差异有统计学意义(均P<0.05)。结论:对老年髋臼骨折患者而言,采用人工关节置换术进行治疗具有更好的临床效果,可以明显缩短患者住院天数以及下地负重时间,降低并发症发生率,对患者髋关节功能具有显著改善作用,能够明显减少患者体内炎症反应,改善骨代谢指标水平。

Objective:To explore the effect of artificial joint replacement on serum inflammatory indexes and bone metabolism in elderly patients with acetabular fractures.Methods:A total of 120 elderly patients with acetabular fractures were selected and divided into observation group(60 cases)and control group(60 cases)according to random number table method.Patients in the control group were treated with internal fixation,and patients in the observation group were treated with artificial joint replacement.The operation time,intraoperative blood loss,intraoperative and postoperative blood transfusion,postoperative drainage volume and hospital stay were compared between two groups.The Harris score was used to evaluate the hip joint function of the two groups before and 3 months after operation.The levels of serum inflammatory factors interleukin-6,C-reactive protein and serum procalcitonin before and after surgery were compared between two groups.Bone mineral density level,and the bone metabolism levels of serum osteocalcin,parathyroid hormone,bone alkaline phosphatase before and after surgery were compared between two groups.The incidence of side effects such as wound infection,lower extremity phlebitis,traumatic osteoarthritis and sciatic nerve injury were compared between two groups.Results:The operation time and intraoperative blood loss of observation group were significantly higher than those of control group,and the weight-bearing time and hospital stay of observation group were significantly less than those of control group(all P<0.05).There was no significant difference in hip function score before operation between two groups(P>0.05),but the hip function score at 3 months after operation in observation group was higher than that in control group(P<0.05).There was no significant difference in serum inflammatory factor levels before operation between two groups(all P>0.05),but the serum inflammatory factor levels after operation in observation group were lower than those in control group(all P<0.05).There was no significant difference in the levels of OC,PTH,BALP and BMD before operation between two groups(P>0.05),and those in the two groups were improved after the operation,and the levels of OC,PTH,BALP and BMD in observation group were higher than those in control group(all P<0.05).Compared with control group,the observation group has fewer cases of side effects such as incision infection,lower extremity phlebitis,traumatic osteoarthritis and sciatic nerve injury,and the overall incidence of adverse reactions was significantly reduced(all P<0.05).Conclusion:For elderly patients with acetabular fractures,the use of artificial joint replacement has better clinical effect,which can significantly shorten hospital stay and the weight-bearing time of the patient,reduce the incidence of complications,and has significant improvement effect on the hip joint function of the patient,and significantly reduce the inflammatory reaction in the patient’s body,improve the levels of bone metabolism indexes.