近端防旋髓内钉内固定对股骨转子间骨折患者的治疗效果

Effect of Proximal Anti-Rotation Intramedullary Nail Fixation on Patients with Intertrochanteric Fracture

目的:探讨与分析近端防旋髓内钉内固定对股骨转子间骨折患者的治疗效果.方法:选择2018年8月—2022年7月于陇西县第二人民医院进行择期手术的83例转子间骨折患者作为研究对象,根据1:1随机掷硬币原则把83例患者分为髓内钉组(n=42)与钢板组(n=41),髓内钉组采用近端防旋髓内钉内固定治疗,钢板组采用钢板内固定治疗,比较2组术后功能恢复及血清骨形态发生蛋白-2(BMP-2)、转化生长因子-β1(TGF-β1)表达变化情况.结果:和钢板组比较,髓内钉组的术中出血量减少,并且手术时间、术后住院时间及术后下床活动时间也更短,组间差异有统计学意义(P<0.05).2组术后1个月的血清骨形态发生蛋白-2、转化生长因子-β1含量都高于术前1 d,髓内钉组术后1个月的血清骨形态发生蛋白-2、转化生长因子-β1含量明显高于钢板组,差异均有统计学意义(P<0.05).术后6个月髓内钉组髋关节功能Harris评分优良率显著高于钢板组,组间差异有统计学意义(P<0.05).髓内钉组术后6个月的静脉血栓形成、髋内翻、切口感染、褥疮等并发症发生率为7.14%,显著低于对照组的24.40%,组间差异有统计学意义(P<0.05).结论:近端防旋髓内钉内固定在股骨转子间骨折患者的应用能减少术中出血量,缩短手术时间、术后住院时间及术后下床活动时间,促进血清骨形态发生蛋白-2、转化生长因子-β1的分泌,提高患者的髋关节功能,降低并发症发生率.

Objective:To investigate and analyze the effects of proximal anti-rotation intramedullary nail fixation on patients with intertrochanteric fracture.Methods:83 patients with intertrochanteric fracture undergoing selective surgery in the second people's hospital of Longxi county from August 2018 to July 2022 were selected as the study objects.The 83 patients were divided into an intramedullary nail group(n=42)and a plate group(n=41)according to the 1:1 random coin toss principle.The intramedullary nail group was treated with proximal anti-rotation intramedullary nail and internal fixation.The functional recovery and the expression of bone morphogenetic protein-2(BMP-2)and transforming growth factor-β1(TGF-β1)were compared between the two groups.Results:Compared with the plate group,the intramedullary nail group had less intraoperative blood loss,and shorter operation time,postoperative hospital stay and postoperative activity time,with statistical significance(P<0.05).The contents of bone morpheo-protein-2 and transforming growth factor-β1 in serum of 2 groups 1 month after surgery were higher than those of 1 day before surgery,and the contents of bone morpheo-protein-2 and transforming growth factor-β1 in serum of intramedullary nail group 1 month after surgery were significantly higher than those of plate group,with statistical significance(P<0.05).6 months after surgery,the Harris score of hip function in the intramedullary nail group was significantly higher than that in the plate group,and the difference was statistically significant(P<0.05).The incidence of venous thrombosis,coxal varus,incision infection,bedsore and other complications in the intramedullary nailing group was 7.14%,significantly lower than 24.40%in the control group,and the difference was statistically significant(P<0.05).Conclusion:The application of proximal anti-rotation intramedullary nail in patients with intertrochanteric fracture can reduce the amount of intraoperative blood loss,shorten the operation time,postoperative hospitalization time and postoperative activity time,promote the secretion of serum bone morphogenetic protein-2 and transforming growth factorβ1,improve the hip function of patients,and reduce the incidence of complications.