股骨近端防旋髓内钉远端静力化锁定与动力化锁定治疗不稳定性股骨转子间骨折患者的效果比较

Comparison of the effect of distal static locking and dynamic locking of proximal femoral anti-rotation intramedullary nail in the treatment of patients with unstable intertrochanteric fractures

目的比较股骨近端防旋髓内钉远端静力化锁定与动力化锁定治疗不稳定性股骨转子间骨折患者的效果。方法选择2020年1月至2023年2月90例接受手术治疗的不稳定性股骨转子间骨折患者为研究对象,以随机数字表法将其分为对照组、观察组,每组45例。对照组接受股骨近端防旋髓内钉远端动力化锁定治疗,观察组接受股骨近端防旋髓内钉远端静力化锁定治疗。比较两组的治疗效果。结果观察组的固定质量Ⅰ级占比高于对照组,Ⅱ、Ⅲ及Ⅳ级占比低于对照组(P<0.05)。观察组的治疗总有效率为97.78%,高于对照组的86.67%(P<0.05)。术后48 h,观察组的C-反应蛋白(CRP)、促肾上腺皮质激素(ACTH)、前列腺素E2(PGE2)及促肾上腺皮质激素释放激素(CRH)水平均低于对照组(P<0.05)。术后6个月,观察组的Harris髋关节功能评分量表(HHS)、Holden步行功能分级(FAC)及功能独立性评定量表(FIM)评分均高于对照组(P<0.05)。结论股骨近端防旋髓内钉远端静力化锁定用于不稳定性股骨转子间骨折患者中,可提高固定质量,缓解创伤应激反应,促进肢体功能恢复。

Objective To compare the effect of distal static locking and dynamic locking of proximal femoral anti-rotation intramedullary nail in the treatment of patients with unstable intertrochanteric fractures.Methods A total of 90 patients with unstable intertrochanteric fractures who underwent surgical treatment from January 2020 to February 2023 were selected as the research objects.The patients were divided into control group and observation group by random number table method,with 45 cases in each group.The control group received distal dynamic locking treatment of proximal femoral anti-rotation intramedullary nail,and the observation group received distal static locking treatment of proximal femoral anti-rotation intramedullary nail.The therapeutic effects of the two groups were compared.Results The proportion of fixed quality gradeⅠin the observation group was higher than that in the control group,and the proportion of gradeⅡ,ⅢandⅣwere lower than those in the control group(P<0.05).The total effective rate of treatment in the observation group was 97.78%,which was higher than 86.67%in the control group(P<0.05).At 48 h after operation,the levels of C-reactive protein(CRP),adrenocorticotropic hormone(ACTH),prostaglandin E2(PGE2)and corticotropin releasing hormone(CRH)in the observation group were lower than those in the control group(P<0.05).At 6 months after operation,the scores of Harris Hip Score(HHS),Functional Ambulation Category(FAC)and Functional Independence Measure(FIM)in the observation group were higher than those in the control group(P<0.05).Conclusion The distal static locking of proximal femoral anti-rotation intramedullary nail applied in patients with unstable intertrochanteric fractures can improve the fixation quality,relieve the traumatic stress response and promote the recovery of limb function.