不同股骨近端重建顺序对老年重度骨质疏松不稳定型转子间骨折行股骨头置换患者术后髋关节功能的影响

Effect of different proximal femoral reconstruction sequences on postoperative hip joint function in elderly patients with severe osteoporotic unstable intertrochanteric fractures undergoing hemiarthroplasty

目的探讨不同股骨近端重建顺序对老年重度骨质疏松不稳定型转子间骨折行股骨头置换患者术后髋关节功能的影响。方法前瞻性选择2022年1月至2024年1月在成都市龙泉驿区第一人民医院骨科治疗的68例重度骨质疏松不稳定型转子间骨折患者作为研究对象,按随机数表法分为对照组和观察组各34例。两组患者均施行人工股骨头置换术,对照组先重建股骨近端骨折再植入股骨假体,观察组先植入股骨假体再重建股骨近端骨折,比较两组患者的手术相关指标(手术时间、术中出血量、术后首次下床活动时间、住院时间)、术前及术后1个月、3个月、6个月髋关节Harris评分、术后6个月假体相关指标(假体松动率、假体下沉距离)及并发症发生情况(切口感染、下肢深静脉血栓形成、坠积性肺炎等)。结果观察组患者的手术时间、术中出血量、术后首次下床活动时间、住院时间分别为(67.25±7.13)min、(120.76±27.65)mL、(4.03±0.67)d、(14.83±2.45)d,明显短(少)于对照组的(78.82±8.47)min、(142.98±33.59)mL、(5.59±0.72)d、(18.06±3.11)d;差异均有统计学意义(P<0.05);观察组患者术后1个月、3个月、6个月的Harris评分分别为(64.57±8.24)分、(72.68±7.65)分、(87.95±7.10)分,明显高于对照组的(55.36±8.49)分、(62.41±8.03)分、(78.57±7.62)分,差异均有统计学意义(P<0.05);观察组患者术后6个月的假体松动率、假体下沉距离和并发症总发生率分别为2.94%、(1.67±0.24)mm、5.88%,明显低(短)于对照组的23.53%、(1.93±0.37)mm、23.53%,差异均有统计学意义(P<0.05)。结论人工股骨头置换术股骨近端重建按照先行假体植入再重建股骨近端骨折的顺序治疗老年重度骨质疏松不稳定型转子间骨折的效果更好,能缩短手术时间,减少术中出血量,降低假体松动率及假体下沉距离,提高髋关节功能。

Objective To investigate the effects of different proximal femoral reconstruction sequences on hip joint function in elderly patients with severe osteoporotic unstable intertrochanteric fractures undergoing hemiarthroplasty.Methods A total of 68 patients with severe osteoporotic unstable intertrochanteric fracture treated in the Department of Orthopedics,the First People's Hospital of Longquanyi District,Chengdu from January 2022 to January 2024 were prospectively selected and divided into a control group and an observation group,with 34 patients in each group.All the patients underwent hemiarthroplasty.The control group first reconstructed the proximal femoral fracture and then implanted the femoral prosthesis,and the observation group first implanted the femoral prosthesis and then reconstructed the proximal femoral fracture.The two groups were compared in the following aspects:the operation-related indexes(operation duration,intraoperative blood loss,time of first postoperative ambulation,length of hospital stay);hip Harris score before surgery and at 1 month,3 months,and 6 months after surgery;and prosthesis-related indexes(prosthesis loosening rate,prosthesis sinking distance)and complications(incision infection,deep vein thrombosis of the lower extremities,hypostatic pneumonia)at 6 months after surgery.Results The operation duration,intraoperative blood loss,time of first postoperative ambulation,and length of hospital stay in the observation group were(67.25±7.13)min,(120.76±27.65)mL,(4.03±0.67)d,and(14.83±2.45)d,respectively,which were significantly shorter(less)than(78.82±8.47)min,(142.98±33.59)mL,(5.59±0.72)d,and(18.06±3.11)d in the control group(P<0.05).The Harris scores of the observation group at 1 month,3 months,and 6 months after surgery were(64.57±8.24)points,(72.68±7.65)points,and(87.95±7.10)points,respectively,which were significantly higher than(55.36±8.49)points,(62.41±8.03)points,and(78.57±7.62)points in the control group(P<0.05).The prosthesis loosening rate,prosthesis sinking distance,and the overall incidence of complications in the observation group were 2.94%,(1.67±0.24)mm,and 5.88%,respectively,which were significantly lower(shorter)than 23.53%,(1.93±0.37)mm,and 23.53%in the control group(P<0.05).Conclusion Hemiarthroplasty with proximal femoral reconstruction in the order of prosthesis implantation and then re-construction of proximal femoral fractures has a better effect in the treatment of elderly patients with severe osteoporotic unstable intertrochanteric fractures,which can shorten the operation duration,reduce the intraoperative blood loss,re-duce the prosthesis loosening rate and prosthesis sinking distance,and improve hip joint function.