新型组合微创半髋置换术治疗老年骨质疏松性股骨转子间骨折效果观察

Observation of Effect of Novel Combined Minimally Invasive Semi-hip Replacement in the Treatment of Senile Osteoporotic Intertrochanteric Fracture of Femur

目的探究新型组合微创半髋置换术治疗老年骨质疏松性股骨转子间骨折的效果及安全性。方法选取2019年1月至2023年1月收治的老年骨质疏松性股骨转子间骨折患者102例,采用1∶1∶1配对原则分为3组各34例,其中行新型组合微创半髋置换术患者作为微创组、行人工关节置换术患者作为关节置换组、行股骨近端防旋髓内钉(PFNA)内固定术患者作为内固定组。比较3组手术相关指标,手术前后应激反应指标[促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)、肾上腺素]、Harris评分,以及术后12个月髋关节恢复优良率、再入院率和术后并发症发生率。结果微创组和内固定组手术时间、切口总长度、术中出血量、术后引流量、术后下床活动时间、住院时间及骨折愈合时间较关节置换组缩短或减少(P<0.05)。术后1 d及术后3 d,微创组、内固定组ACTH、NE、肾上腺素水平低于关节置换组(P<0.05)。术后6个月及术后12个月,3组Harris髋关节功能量表疼痛、功能、关节活动度、肢体畸形评分比较:微创组>内固定组>关节置换组(P<0.05)。术后12个月,3组髋关节恢复优良率比较差异无统计学意义(P>0.05)。微创组、内固定组术后并发症发生率、再入院率均低于关节置换组(P<0.05,P<0.01)。结论相较于人工关节置换术治疗老年骨质疏松性股骨转子间骨折,新型组合微创半髋置换术与PFNA内固定术能优化手术流程、提高手术安全性、降低再入院风险,并可减轻应激反应、促进骨折愈合,且前者改善髋关节功能效果更佳。

Objective To explore the efficacy and safety of novel combined minimally invasive semi-hip replacement in the treatment of senile osteoporotic intertrochanteric fracture of femur.Methods A total of 102 elderly patients with osteoporotic intertrochanteric fracture of femur treated from January 2019 to January 2023 were selected and divided into three groups with 34 patients in each group using 1∶1∶1 pairing principle.Patients who underwent minimally invasive semi-hip replacement were selected as the minimally invasive group,patients who underwent artificial joint replacement were selected as the joint replacement group,and patients who underwent proximal femoral nail antirotation(PFNA)internal fixation were selected as the internal fixation group.The operation-related indexes,stress response indexes[adrenocorticotropic hormone(ACTH),norepinephrine(NE),epinephrine]before and after operation,Harris score,excellent and good rate of hip recovery,postoperative complication rate and readmission rate of the three groups were compared.Results The duration of operation,total incision length,intraoperative blood loss,postoperative drainage volume,time of postoperative off-bed activity,length of hospital stay and fracture healing time in minimally invasive group and internal fixation group were shorter or less than those in joint replacement group(P<0.05).The levels of ACTH,NE and epinephrine in minimally invasive group and internal fixation group were lower than those in joint replacement group(P<0.05).At 6 months and 12 months after surgery,the Harris scale pain,function,joint motion and limb deformity scores of the three groups were compared,showing the highest scores in minimally invasive group,followed by internal fixation group and joint replacement group(P<0.05).At 12 months after operation,there was no significant difference in the excellent and good rate of hip function recovery among the three groups(P>0.05).The rates of complications and readmission at 12 months after surgery in the minimally invasive group and the internal fixation group were lower than those in the joint replacement group(P<0.05,P<0.01).Conclusion Compared with artificial joint replacement in the treatment of senile osteoporotic intertrochanteric fracture,the new combined minimally invasive semi-hip replacement and PFNA can optimize the surgical process,improve the surgical safety,lower the risk of readmission,reduce the stress reaction and promote fracture healing,but the former has a better effect on improving hip function.