强筋壮骨丸配合动力髋螺钉、股骨近端防旋刀片髓内钉和新型股骨近端髓内钉治疗骨质疏松性股骨粗隆间骨折的临床效果分析

Clinical Effect of Qiangjin Zhuanggu Pill Combined with Dynamic Hip Screw,Proximal Femoral Anti-rotation Blade Intramedullary Nail and New Proximal Femoral Intramedullary Nail in the Treatment of Osteoporotic Femoral Intertrochanteric Fractures

目的:通过动力髋螺钉(dynamic hip screw,DHS)、股骨近端防旋刀片髓内钉(proximal femoral nail antirotation,PFNA)和新型股骨近端髓内钉(new proximal femoral intramedullary nail,Inter Tan)三种方法对老年股骨粗隆间骨折(intertrochanteric femur fracture,IFF)的疗效分析和术后康复比较。方法:回顾研究自2015年7月—2019年7月南京中医药大学附属盐城市中医院收治的60例老年IFF患者作为研究对象,按手术方式分为三组,每组各20例。DHS组实施DHS治疗,PFNA组实施PFNA治疗,Inter Tan组实施Inter Tan治疗,术后均服用院内制剂强筋壮骨丸抗骨质疏松治疗。比较三组患者术中手术时间、出血量、术后隐形失血、下床时间、住院时间、骨折愈合时间及髋关节功能评分等之间的差异以及后期的并发症等。结果:手术时间Inter Tan组较PFNA组长,DHS组最长;术中出血量Inter Tan组较PFNA组少,DHS组最多;术后检测血常规,术后隐形失血Inter Tan组和PFNA组都减少,PFNA组更明显些,DHS组变化不大;DHS组下床活动时间较PFNA组和Inter Tan组晚;术后功能恢复上治疗12个月后髋关节功能与生活质量评分比较Inter Tan组、PFNA组、DHS组无明显区别;后期并发症与Inter Tan组未见明显并发症,PFNA组出现主钉切割和股骨头坏死各1例,DHS组出现髋内翻2例和1例因血糖高局部脂肪液化感染后痊愈等并发症,差异有统计学意义(P<0.05)。结论:三者比较,DHS、PFNA和Inter Tan都可以治疗IFF,但Inter Tan的手术方式因术中出血量少、术后卧床时间短,更适用于骨质疏松性IFF。

Objective:By comparing dynamic hip screw(DHS),proximal femoral anti-rotation blade intramedullary nail(PFNA)and new proximal femoral intramedullary nail(Inter Tan)three methods,to analyze the efficacy and post-operative recovery of intertrochanteric fractures(IFF)in the elderly.Methods:A total of 60 elderly patients with IFF admitted to the hospital from July 2015 to July 2019 were selected as the research objects,and divided into three groups according to the surgical method,with 20 cases in each group.The DHS group received DHS therapy,the PFNA group received PFNA therapy,and the Inter Tan group received Inter Tan therapy.After the operation,all patients took the hospital preparation Qiangjinzhuanggu pills for anti-osteoporosis treatment.The differences in intraoperative operation time,blood loss,postoperative invisible blood loss,time to get out of bed,hospital stay,fracture healing time,hip function score,and later complications were compared among the three groups.Results:The operation time of the Inter Tan group was longer than that of the PFNA group,and the DHS group was the longest.The intraoperative blood loss in the Inter Tan group was less than that in the PFNA group,and the most in the DHS group.Postoperative blood routine test showed that postoperative invisible blood loss decreased in both Inter Tan group and PFNA group,more obvious in PFNA group,and little change in DHS group.The time of getting out of bed in the DHS group was later than that in the PFNA group and the Inter Tan group.After 12 months of treatment,there was no significant difference in hip function and quality of life scores between Inter Tan group,PFNA group and DHS group.There were no obvious complications in the Inter Tan group.In the PFNA group,there were 1 case of main nail cutting and 1 case of necrosis of the femoral head.In the DHS group,2 cases of coxa varus and 1 case of recovery from infection due to high blood sugar and local fat liquefaction occurred.The differences were statistically significant(P<0.05).Conclusion:DHS,PFNA,and Inter Tan can all treat IFF,but Inter Tan’s surgery is more suitable for osteoporotic IFF due to less intraoperative blood loss and shorter postoperative bed rest.