骨水泥型与生物型假体半髋置换治疗老年股骨颈骨折的创伤程度及对患者骨代谢的影响

Degree of trauma in the treatment of senile femoral neck fractures with bone cement and biologic prosthesis hemihip replacement and the effect on bone metabolism of patients

目的探讨骨水泥型与生物型假体半髋置换对老年股骨颈骨折的创伤程度及对患者骨代谢的影响。方法选取2018年1月至2020年6月本院收治的129例老年股骨颈骨折患者作为研究对象,随机分为观察组(n=65)与对照组(n=64)。观察组予以生物型假体半髋置换治疗,对照组予以骨水泥型假体半髋置换治疗,比较两组临床疗效、围术期应激激素水平、骨代谢指标及并发症发生情况。结果观察组治疗总有效率为95.31%,高于对照组的81.53%(P<0.05);术后1 d,观察组肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)水平低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率低于对照组,差异有统计学意义(P<0.05);两组手术前后β-胶原特殊序列(β-CTX)、总Ⅰ型胶原氨基端延长肽(tPINP)、全段甲状旁腺激素(iPTH)和骨碱性磷酸酶(BALP)水平比较差异无统计学意义。结论骨水泥型与生物型假体半髋置换对老年股骨颈骨折患者骨代谢影响无明显差异,但生物型假体半髋置换对患者创伤程度更低,患者应激反应更小,术后并发症更少,更适用于合并基础疾病的老年患者。

Objective To investigate the effect of degree of trauma in the treatment of senile femoral neck fractures with bone cement and biologic prosthesis hemihip replacement and the effect on bone metabolism of patients.Methods 129 elderly patients with femoral neck fractures from January 2018 to June 2020 in our hospital were selected as the research subjects,and they were randomly divided into the observation group(n=65)and the control group(n=64).The observation group was treated with biological prosthetic hip replacement,and the control group was treated with bone cement prosthetic hip replacement,the clinical efficacy,perioperative stress hormone levels,bone metabolism and complications were compared between the two groups.Results The total effective rate of the observation group was 95.31%,which was higher than 81.53%of the control group(P<0.05).One day after surgery,the levels of epinephrine(E),noradrenaline(NE)and cortisol(Cor)in the observation group were lower than those in the control group,and the difference were statistically significant(P<0.05).The incidence of complications in observation group was lower than that in control group,and the difference was statistically significant(P<0.05).There were no significant differences inβ-crosslaps(β-CTX),total propeptide of type I procollagen(tPINP),intact para thyroid hormone(iPTH)and bone alkaline phosphatase(BALP)levels between the two groups before and after surgery.Conclusion There is no significant difference between cemented type and biological prosthetic hip replacement on bone metabolism in elderly patients with femoral neck fractures,but biological prosthetic hip replacement has lower trauma and less stress response in patients,there are fewer complications and it is more suitable for elderly patients with underlying diseases.