人工股骨头置换术结合股骨距重建治疗高龄不稳定性股骨转子间骨折的临床效果分析

Clinical effects of artificial femoral head replacement combined with femoral reconstruction in the treatment of senile unstable femoral intertrochanteric fracture

目的 探讨人工股骨头置换术结合股骨距重建治疗高龄不稳定性股骨转子间骨折的临床效果。方法 80例高龄不稳定性股骨转子间骨折患者,按照随机数字表法分为对照组和观察组,每组40例。对照组实施人工股骨头置换术治疗,观察组实施人工股骨头置换术结合股骨距重建治疗。比较两组手术指标(手术时间、术中出血量和术后引流时间),关节抗压能力值及内固定材料刚度值,手术前后Harris髋关节功能评分,术后3个月下肢运动功能(10 m步行耗时、辅助行走时间、独立行走时间),并发症发生情况。结果 两组手术时间、术中出血量比较差异无统计学意义(P>0.05);观察组术后引流时间(2.51±0.63)d短于对照组的(2.92±0.81)d,差异具有统计学意义(P<0.05)。观察组关节抗压能力值、内固定材料刚度值分别为(2.22±0.13)MPa、(1852.82±389.73)N/mm,均高于对照组的(1.81±0.20)MPa、(1274.91±275.84)N/mm,差异具有统计学意义(P<0.05)。术后3个月,两组Harris髋关节功能评分均高于本组术前,且观察组Harris髋关节功能评分(79.02±11.10)分高于对照组的(53.81±13.21)分,差异具有统计学意义(P<0.05)。术后3个月,观察组10 m步行耗时(25.80±10.81)s短于对照组的(51.81±15.51)s,辅助行走时间(6.51±2.32)d、独立行走时间(2.44±0.72)个月均早于对照组的(8.82±3.11)d、(3.90±1.13)个月,差异具有统计学意义(P<0.05)。观察组并发症发生率为2.50%,低于对照组的27.50%,差异具有统计学意义(P<0.05)。结论 针对高龄不稳定性股骨转子间骨折患者,给予人工股骨头置换术结合股骨距重建治疗并不增加手术时间与术中出血量,可显著提高内固定材料稳固性与刚度,有利于患者术后髋关节和下肢运动功能恢复,且并发症少,安全性高。

Objective To investigate the clinical effects of artificial femoral head replacement combined with femoral reconstruction in the treatment of senile unstable femoral intertrochanteric fractures. Methods 80 senile patients with unstable femoral intertrochanteric fracture were randomly divided into a control group and an observation group, with 40 cases in each group. Patients of the control group were treated with artificial femoral head replacement, and patients of the observation group were treated with artificial femoral head replacement combined with femoral reconstruction. The surgery indexes(surgery time, intraoperative bleeding amount and postoperative drainage time), compressive capacity of joints, stiffness of internal fixation materials, Harris Hip score before and after the surgery, lower limb motor function(walking time for 10 m, auxiliary walking time,independent walking time) and incidence of complications were compared between the two groups. Results The differences in surgery time and intraoperative bleeding amount between the two groups were not statistically significant(P>0.05). The postoperative drainage time of the observation group was(2.51±0.63) d, which was shorter than(2.92±0.81) d of the control group, and the difference was statistically significant(P<0.05). The compressive capacity of joints of the observation group was(2.22±0.13) MPa, and the stiffness of internal fixation materials of the observation group was(1852.82±389.73) N/mm, which were higher than(1.81±0.20) MPa and(1274.91±275.84) N/mm of the control group, respectively, and the differences were statistically significant(P<0.05). 3 months after the surgery, Harris Hip scores of the two groups were higher than those before the surgery;Harris Hip score of the observation group was(79.02±11.10) points, which was higher than(53.81±13.21) points of the control group;and the differences were statistically significant(P<0.05). 3 months after the surgery, the walking time for 10 m of the observation group was(25.80±10.81) s, which was shorter than(51.81±15.51) s of the control group;the auxiliary walking time of the observation group was(6.51±2.32) d, which was shorter than(8.82±3.11) d of the control group;the independent walking time of the observation group was(2.44±0.72) months, which was earlier than(3.90±1.13) months of the control group;and the differences were statistically significant(P<0.05). The incidence of complications of the observation group was 2.50%, which was lower than 27.50% of the control group, and the difference was statistically significant(P<0.05). Conclusion For the senile patients with unstable femoral intertrochanteric fracture, artificial femoral head replacement combined with femoral reconstruction can significantly improve the stability and stiffness of internal fixation materials without increasing the surgery time or the intraoperative bleeding amount, which is profit to the recovery of hip joint and lower limb motor function after surgery. Further, this strategy had low incidence of complications and high safety.