不同手术时机治疗对老年股骨颈骨折患者的近远期疗效比较

Comparison of the short-termand long-termcurative effect of different surgical timing treatment on elderly patients with femoral neck fracture

目的探讨不同手术时机治疗对老年股骨颈骨折患者的近远期疗效。方法选取2015年8月至2020年9月北京市朝阳区双桥医院收治的150例股骨颈骨折患者作为研究对象,根据不同手术时机分为观察组与对照组,每组75例。两组均行全髋关节置换术,观察组在入院后4~6 h进行手术,对照组在入院后1~2 d进行手术。比较两组手术时间、术中出血量和住院时间,两组手术前后不同时间点Harris评分,手术前后血清Dickkopf相关蛋白-1(DKK-1)和血清酸性磷酸酶5b(TPAP5b)水平和术后1、12个月临床疗效。结果观察组手术时间、住院时间短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05)。两组Harris评分组间、时间、交互比较差异有统计学意义(P<0.05);组内比较:术后1、3、6、12个月,两组Harris评分术后均高于前一时间点,差异有统计学意义(P<0.05)。组间比较:术前、术后12个月,两组Harris评分比较差异无统计学意义;术后1、3、6个月,观察组Harris评分均高于对照组,差异有统计学意义(P<0.05)。术后,两组DKK-1、TPAP5b水平均低于术前,且观察组低于对照组,差异有统计学意义(P<0.05)。两组治疗总有效率术后1个月与术后12个月比较差异无统计学意义;术后1、12个月,观察组治疗总有效率均高于对照组,差异有统计学意义(P<0.05)。结论对老年股骨颈骨折患者越早进行手术,髋关节功能改善越好,缩短手术时间和住院时间、降低出血量,近远期疗效更好。

Objective To investigate the short-term and long-term curative effects of different surgical timing treatment on elderly patients with femoral neck fracture.Methods 150 patients with femoral neck fracture treated in Shuangqiao Hospital,Chaoyang District,Beijing from August 2015 to September 2020 were selected as the study subjects,and they were divided into the observation group and the control group according to different operation times,with 75 cases in each group.Total hip arthroplasty was performed between the two groups,the operation was performed 4-6 hours after admission in the observation group and 1-2 d after admission in the control group.The operation time,intraoperative blood loss,length of hospital stay,Harris score,serum DICKKOPF-associated protein-1(DKK-1)and serum acid phosphatase 5b(TPAP5b)levels before and after operation and clinical efficacy at 1 and 12 months after operation were compared between the two groups.Results The operation time and hospital stay in the observation group were shorter than those in the control group,and the intraoperative blood loss was less than that in the control group,the differences were statistically significant(P<0.05).There were significant differences in Harris score between the two groups of group,time points and interaction(P<0.05).Comparison within the group:The Harris score of the two groups were higher at each time point after operation than that before time point,and the differences were statistically significant(P<0.05).Comparison between groups:Before operation and 12 months after operation,there was no significant differences in Harris scores between the two groups;at 1,3 and 6 months after operation,the Harris scores in the observation group were higher than those of the control group,and the differences were statistically significant(P<0.05).After operation,DKK-1 and TPAP5b levels of the two groups were lower than before operation,and observation group was lower than control group,the difference was statistically significant(P<0.05).There was no significant difference in the total effective rate between the two groups 1 month after operation and 12 months after operation;at 1 and 12 months after operation,the total effective rate in the observation group was higher than that in the control group,the difference was statistically significant(P<0.05).Conclusion For elderly patients with femoral neck fracture,the earlier the operation is performed,the better the hip function can be improved,the operation time and hospital stay can be shortened,the amount of blood loss can be reduced,and the short and long term curative effect is better.