下肢骨折牵引复位装置辅助PFNA内固定术在EvansⅢ型、Ⅳ型股骨粗隆间骨折中的应用

Application of lower extremity fracture traction reduction device assisted PFNA internal fixation in EvansⅢandⅣtype intertrochanteric fractures of femur

目的探讨下肢骨折牵引复位装置辅助股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定术在EvansⅢ型、Ⅳ型股骨粗隆间骨折中的应用。方法收集周口骨科医院2020年1月-2022年1月的EvansⅢ型、Ⅳ型股骨粗隆间骨折患者96例,按照随机数字方法分为对照组及观察组,均48例,对照组采用髋关节置换术,观察组行下肢骨折牵引复位装置辅助PFNA内固定术治疗,观察两组患者手术一般指标、临床疗效、髋关节功能、疼痛评分、氧化应激情况及术后并发症。结果与对照组相比,观察组患者术中出血量、手术时间、住院时间、切口长度、下地负重时间均降低(P<0.05);对照组患者临床总有效率为79.17%,观察组患者临床总有效率为93.75%,观察组临床疗效优于对照组(P<0.05);两组患者术前髋关节功能量表(Harris)评分及视觉模拟评分法(VAS)评分无统计学差异(P>0.05),与术前相比,术后3个月、6个月的Harris评分升高,VAS评分降低(P<0.05),术后3个月、6个月,与对照组相比,观察组患者Harris评分升高,VAS评分降低(P<0.05);两组患者术前甲肾上腺素(norepinephrine,NE)、超氧化物歧化酶(superoxidedismutase,SOD)、血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)水平无无统计学差异(P>0.05),与术前相比,术后7 d的NE、SOD及AngⅡ水平升高(P<0.05),术后7 d,与对照组相比,观察组患者NE、SOD及AngⅡ水平降低(P<0.05);对照组患者术后并发症的发生率为33.33%,观察组患者术后并发症的发生率为14.58%,与对照组相比,观察组术后并发症降低(P<0.05)。结论下肢骨折牵引复位装置辅助PFNA内固定术可显著提高EvansⅢ型、Ⅳ型股骨粗隆间骨折患者临床疗效,改善髋关节功能,降低疼痛,与髋关节置换术相比术后应激程度较小,并发症较低,值得应用。

Objective To investigate the application of lower extremity fracture traction reduction device assisted PFNA internal fixation in Evans Ⅲ and Ⅳ type intertrochanteric fracture of femur.Methods A total of 96 patients with Evans type Ⅲ and Ⅳ intertrochanteric fracture of femur in our hospital from January 2020 to January 2022 were collected and divided into control group and observation group according to random number method,with 48 cases in both.The control group received hip replacement,and the observation group received traction reduction device assisted PFNA internal fix-ation treatment for lower limb fracture.The general indexes,clinical efficacy,hip function,pain score,oxidative stress and postoperative complications were observed in the two groups.Results Compared with control group,intraoperative blood loss,operation time,hospital stay,incision length and weight-bearing time in observation group were all de-creased(P<0.05).The total clinical effective rate of the control group was 79.17%,and the total clinical effective rate of the observation group was 93.75%.The clinical effect of the observation group was better than that of the control group(P<0.05).Preoperative Harris scores and VAS scores of the two groups were no statistical significance(P>0.05).Compared with preoperative Harris scores,postoperative Harris scores were higher and postoperative VAS scores were lower at 3 and 6 months(P<0.05).Postoperative Harris scores of the observation group were higher than those of the control group at 3 and 6 months.VAS score decreased(P<0.05);The levels of NE,SOD and AngⅡ in the two groups were no statistical significance before surgery(P>0.05),and the levels of NE,SOD and AngII were in-creased 7 days after surgery(P<0.05),and the levels of NE,SOD and AngⅡ in the observation group were decreased 7 days after surgery compared with the control group(P<0.05).The incidence of postoperative complications was 33.33%in the control group and 14.58%in the observation group.Compared with the control group,the incidence of postoperative complications was decrease in the observation group(P<0.05).Conclusion Lower extremity fracture traction reduction device assisted PFNA internal fixation can significantly improve the clinical efficacy of patients with EvansⅢandⅣintertrochanteric fracture of femur,improve hip function,reduce pain,compared with hip replacement,postoperative stress degree is smaller,lower complications,worthy of application.