防旋股骨近端髓内钉固定术和关节置换术治疗股骨转子间骨折的效果

Effectiveness of anti rotation proximal femoral nail fixation and joint replacement in the treatment of intertrochanteric fractures of the femur

目的探讨防旋股骨近端髓内钉(PFNA)固定术和关节置换术治疗股骨转子间骨折的效果分析。方法选取2019年1月至2022年12月商丘市第一人民医院收治的104例股骨转子间骨折患者作为研究对象, 根据患者手术方式, 分为PFNA组和关节置换组, 每组52例, PFNA组患者采用防旋股骨近端髓内钉(PFNA)固定术进行治疗, 关节置换组患者采用人工髋关节置换术进行治疗。分别对两组手术方式的手术情况进行比较;并对比两组患者术后完全负重时间、视觉模拟评分(VAS)、髋伸屈活动度(ROM)、髋关节功能恢复情况(Harris评分)以及术后并发症发生。组间比较采用t检验。结果 PFNA组患者手术时间、手术出血量、术后引流量、骨折愈合时间、住院时间[(85.83±7.93) min、(242.54±17.35) ml、(129.35±12.43) ml、(124.86±9.81) d、(11.37±1.99) d]明显高于关节置换组患者[(69.67±6.10) min、(185.88±15.73) ml、(96.08±12.75) ml、(96.46±11.22) d、(7.17±1.00) d], 差异有统计学意义(t=11.640、17.440、13.740、13.040、13.560, P<0.05)。PFNA组患者VAS评分、髋伸屈活动度[(2.81±0.89)分、(118.65±7.51)°]明显低于关节置换组患者[(2.06±0.73)分、(130.54±6.89)°], 差异有统计学意义(t=4.722、8.409, P<0.05)。PFNA组患者髋关节功能[(69.10±5.09)分]明显低于关节置换组患者[(80.27±4.62)分], 差异有统计学意义(t=11.710, P<0.05)。关节置换组治疗后炎性因子TNF-α和IL-6水平[(24.56±3.71) pg/ml、(48.69±3.71) pg/ml]明显低于PFNA组患者[(30.22±2.17) pg/ml、(58.65±4.01) pg/ml], 差异有统计学意义(t=4.581、5.008, P<0.05)。关节置换组患者内固定并发症、髋关节并发症等发生率[1.92%(1/52)]明显低于PFNA组[9.61%(5/52)], 差异均有统计学意义(χ^(2)=2.216, P<0.05)。结论人工髋关节置换术治疗股骨转子间骨折效果显著, 患者术后住院时间短, 并发症低, 术后疼痛和关节功能改善较为显著。

Objective To explore the effectiveness of anti rotation proximal femoral nail(PFNA)fixation and joint replacement in the treatment of intertrochanteric fractures of the femur.Methods Totally,104 patients with intertrochanteric fractures of the femur admitted to our hospital from January 2019 to December 2022 were selected as the research subjects.According to the surgical methods,the patients were divided into a PFNA group and a joint replacement group,with 52 patients in each group.The PFNA group patients were treated with anti rotation PFNA fixation,and the joint replacement group patients were treated with artificial total hip replacement.The surgical outcomes of surgical methods were compared.The postoperative complete weight-bearing time,visual analogue scale(VAS),hip range of motion(ROM),hip joint function recovery(Harris score),and incidence of postoperative complications were evaluated.The comparison of inter group measurement data was done by thet-test.Results The operation time,surgical bleeding volume,postoperative drainage volume,and fracture healing time in the PFNA group[(85.83±7.93)min,(242.54±17.35)ml,(129.35±12.43)ml,(124.86±9.81)d,(11.37±1.99)d]were significantly increased as compared with those in the joint replacement group[(69.67±6.10)min,(185.88±15.73)ml,(96.08±12.75)ml,(96.46±11.22)d,(7.17±1.00)d,t=11.640,17.440,13.740,13.040,13.560,P<0.05].The VAS score(2.81±0.89)and hip flexion and extension ROM[(118.65±7.51)°]in the PFNA group were significantly decreased as compared with those in the joint replacement group[(2.06±0.73)and(130.54±6.89)°,t=4.722,8.409,P<0.05].The hip joint function in the PFNA group[(69.10±5.09)score]was significantly lower than that in the joint replacement group[(80.27±4.62)score,t=11.710,P<0.05].The levels of inflammatory factors(TNF-αand IL-6)[(24.56±3.71)pg/ml and(48.69±3.71)pg/ml]in the joint replacement group were significantly lower than those in the PFNA group after treatment[(30.22±2.17)pg/ml,(58.65±4.01)pg/ml,t=4.581,5.008,P<0.05].The incidence of internal fixation complications and hip joint complications in the joint replacement group[1.92%(1/52)]was significantly lower than that in the PFNA group[9.61%(5/52),χ^(2)=2.216,P<0.05].Conclusion The treatment of intertrochanteric fractures with artificial total hip arthroplasty is effective,with short postoperative hospital stay,low incidence of complications,and significant improvement in postoperative pain and joint function.