闭合复位髓内钉与髓外钉内固定治疗老年股骨粗隆间骨折疗效对比

Clinical Efficacy of Closed Reduction&Intramedullary Nailing vs.Closed Reduction&Extramedullary Nailing in the Treatment of Intertrochanteric Fractures in Elderly Patients

目的对比分析闭合复位髓内钉内固定与闭合复位髓外钉内固定在老年股骨粗隆间骨折中的应用效果。方法选取2017年10月至2020年10月洛阳市偃师人民医院收治的116例老年股骨粗隆间骨折患者作为研究对象,按照不同治疗方法将其分为髓内固定组(58例)和髓外固定组(58例),髓内固定组患者采用闭合复位髓内钉内固定治疗,髓外固定组患者采用闭合复位髓外钉内固定治疗,对比观察两组患者手术时间、术中出血量、住院时间、骨折愈合时间、创伤性应激反应情况、髋关节功能以及并发症发生情况。结果髓内固定组患者手术时间、住院时间、骨折愈合时间均明显短于髓外固定组(t=21.786、3.842、13.120,P均<0.001),术中出血量明显少于髓外固定组(t=13.668,P<0.001);术后3d,髓内固定组患者血清皮质醇(Cor)、血管紧张素Ⅱ(AngⅡ)、去甲肾上腺素(NE)水平均明显低于髓外固定组(t=5.211、9.756、7.980,P均<0.001);术后6个月,髓内固定组患者Harris评分明显高于髓外固定组(t=7.965,P<0.001);髓内固定组患者术后并发症发生率明显低于髓外固定组(χ^(2)=4.336,P=0.037)。结论与闭合复位髓外钉内固定相比,闭合复位髓内钉内固定更能明显减轻老年股骨粗隆间骨折患者创伤性应激反应,缩短骨折愈合时间,促进髋关节功能恢复。

Objective To compare the clinical efficacy of closed reduction&intramedullary nailing(CRIN)and closed reduction&extramedullary nailing(CREN)in the treatment of intertrochanteric fracture in elderly patients.Methods 116 elderly patients with intertrochanteric fracture,admitted to Luoyang Yanshi People’s Hospital from October 2017 to October 2020,were enrolled as research subjects,and divided into CRIN group(n=58),receiving CRIN,and CREN group(n=58),receiving CREN.The following items including operation time,intraoperative blood loss,length of stay,fracture healing time,traumatic stress response,hip joint function,and occurrence of complications were compared between the two groups.Results Compared with the CREN group,the operation time,length of stay,and fracture healing time of patients in the CRIN group were all significantly shorter(t=21.786,3.842 and 13.120,all P<0.001),and the intraoperative blood loss was significantly less(t=13.668,P<0.001).On day 3 after surgery,the levels of serum cortisol(Cor),angiotensinⅡ(AngⅡ),and norepinephrine(NE)of patients in the CRIN group were significantly lower than that in the CREN group(t=5.211,9.756 and 7.980,all P<0.001).At 6 months after surgery,the Harris score of patients in the CRIN group was significantly higher than that in the CREN group(t=7.965,P<0.001),and the incidence of complications in the CRIN group was significantly lower(χ^(2)=4.336,P=0.037).Conclusion Compared with closed reduction&extramedullary nailing,closed reduction&intramedullary nailing can significantly alleviate traumatic stress response of elderly patients with intertrochanteric fracture,shorten fracture healing time,and promote hip joint function recovery.