股骨近端防旋髓内钉和股骨近端解剖型锁定钢板治疗股骨粗隆间骨折患者的效果及对骨硬化蛋白、DKK-3水平的影响

Effectiveness of proximal femoral nail antirotation versus proximal femoral anatomical locking plate in the treatment of patients with intertrochanteric fracture and their effects on the levels of sclerostin and DKK-3

目的比较研究股骨近端防旋髓内钉(PFNA)和股骨近端解剖型锁定钢板(ALP)治疗股骨粗隆间骨折患者疗效及对血清骨硬化蛋白(SO)、血清Dickkopf-3(DKK-3)水平的影响。方法采用前瞻性研究方法,选取2019年3月至2020年3月滕州市中医医院骨科收治的100例老年股骨粗隆间骨折患者作为研究对象,根据随机数表法将其分为PFNA组(n=50),ALP组(n=50),PFNA组采用PFNA治疗,ALP组采用ALP治疗,分别比较两组一般指标、治疗前后Harris评分、术后负重时间、并发症、SO及DKK-3水平。结果PFNA组切口长度短于ALP组,下地负重时间、手术时间及住院天数均短于ALP组,术中失血量少于ALP组(P<0.05);与治疗前比较,治疗后两组Harris评分均明显上升(P<0.05),且PFNA组高于ALP组(P<0.05);ALP组与PFNA组术后并发症总发生率分别为20.00%,8.00%,PFNA组并发症总发生率明显低于ALP组(P<0.05);治疗前两组DKK-3与SO水平相比,差异无统计学意义(P>0.05);与治疗前比较,治疗后两组DKK-3与SO水平均明显下降(P<0.05),且PFNA组DKK-3与SO水平低于ALP组(P<0.05)。结论与ALP相比,PFNA可有效缩短手术时间,提高髋关节功能,减少并发症发生,降低DKK-3与SO水平,促进骨质修复,抑制骨吸收,减少骨量丢失,利于患者恢复,值得临床上进一步推广。

Objective To investigate and compare the effectiveness of proximal femoral nail antirotation(PFNA)versus proximal femoral anatomical locking plate(ALP)in the treatment of patients with intertrochanteric fracture and their effects on the levels of serum osteosclerosis(SO)and serum Dickkopf-3(DKK-3).Methods With a prospective study method,a total of 100 elderly patients with intertrochanteric fracture who were admitted to the Department of Orthopedics of Tengzhou Traditional Chinese Medical Hospital from March 2019 to March 2020 were selected as the study objects.They were divided into the PFNA group(n=50)and the ALP group(n=50)by the random number table method.The PFNA group was treated with PFNA,while the ALP group was treated with proximal femoral ALP.The general indicators,Harris score before and after treatment,time to postoperative weight-bearing,complications,SO and DKK-3 levels were compared between the two groups.Results The length of incision,time to postoperative weight-bearing,operation time and length of stay in the PFNA group were shorter than those in the ALP group,and the intraoperative blood loss was less than that in the ALP group(P<0.05).Compared with that before treatment,Harris score in both groups increased significantly after treatment(P<0.05),PFNA group was higher than ALP group(P<0.05).The total incidence of postoperative complications in the ALP group and the PFNA group was 20.00%and 8.00%,respectively.The total incidence of complications in the PFNA group was significantly lower than that in the ALP group(P<0.05).There was no statistically significant difference between the levels of DKK-3 and SO in the two groups before treatment(P>0.05).Compared with pre treatment,the levels of DKK-3 and SO in both groups decreased significantly after treatment(P<0.05).The levels of DKK-3 and SO in PFNA group were lower than those in ALP group(P<0.05).Conclusion Compared with ALP,PFNA can effectively shorten the operation time,improve hip joint function,reduce the occurrence of complications,lower DKK-3 and SO levels,promote bone repair,inhibit bone absorption,reduce bone loss,and help patients recover,which is worthy of further promotion in clinical practice.