Effect of early operation with proximal femoral anti-rotation intramedullary nail on the prognosis of elderly patients with intertrochanteric fracture of femur
-
摘要:目的 探讨股骨近端防旋髓内钉(PFNA)早期手术对老年股骨转子间骨折患者预后的影响。方法 选择本院收治的老年股骨转子间骨折患者100例作为研究对象，均行PFNA手术，按照不同手术时机分为观察组和对照组，各50例。观察组于骨折后48 h内行PFNA, 对照组于骨折48 h后行PFNA。随访12个月，比较2组手术时间、术中出血量及输血量、住院时间、住院费用; 比较2组患者术后6、12个月Harris髋关节功能评分状况; 比较2组术后并发症发生情况及病死率。结果 观察组手术时间、术中出血量、输血量、住院时间及费用均显著优于对照组，差异有统计学意义(P < 0.05); 观察组术后6、12个月的Harris髋关节功能评分显著高于对照组(P < 0.05); 观察组术后并发症发生率显著低于对照组(P < 0.05), 但2组病死率比较无显著差异(P>0.05)。结论 对老年股骨转子间骨折患者在早期行PFNA手术，能够缩短住院时间，减少住院费用，同时减少术中输血量及出血量，促进髋关节功能恢复。
-
关键词:
- 股骨转子间骨折 /
- 股骨近端防旋髓内钉 /
- Harris髋关节功能评分 /
- 早期手术
Abstract:Objective To investigate the effect of early operation with proximal femoral anti-rotation intramedullary nail (PFNA) on the prognosis of elderly patients with intertrochanteric fracture of femur.Methods A total of 100 elderly patients with intertrochanteric fracture of femur were selected and treated by PFNA. According to the operation timing, all the patients were divided into control group and observation group, with 50 cases in each group. The observation group was treated with PFNA with in 48 hours after fracture, while the control group was treated with PFNA at 48 hours after tracture. After follow-up for 12 months, the operation time, intra-operative bleeding volume, blood transfusion volume, hospitalization time and hospital expenses were compared between the two groups, the Harris hip function score at 6 and 12 months after operation were compared between the two groups, and the incidence rate of complications and mortality were compared between the two groups.Results The operation time, intra-operative blood loss, blood transfusion, hospitalization time and hospital cost of the observation group were significantly lower than those of the control group (P < 0.05). The Harris hip function score at 6 and 12 months after operation in the observation group were significantly higher than those in the control group (P < 0.05). The incidence rate of complications in the observation group was significantly lower than that in the control group (P < 0.05), but the mortality showed no no significant difference between the two groups (P>0.05).Conclusion Early application of PFNA for elderly patients with intertrochanteric fracture of femur can shorten hospitalization time, reduce hospital costs, reduce blood transfusion and bleeding during operation, and promote the recovery of hip function. -
-
表 1 2组患者相关临床指标比较(x±s)
组别 手术时间/min 术中出血量/mL 输血量/mL 住院时间/d 住院费用/万元人民币 观察组(n=50) 64.25±5.05* 168.90±14.18* 458.33±22.01* 12.09±2.21* 4.03±0.19* 对照组(n=50) 80.26±10.15 196.03±21.17 515.37±44.51 18.52±3.29 4.42±0.25 与对照组比较, *P < 0.05。 
下载: 导出CSV
表 2 2组Harris髋关节功能评分比较(x±s)
分 组别 术前 术后6个月 术后12个月 观察组(n=50) 42.23±4.13 86.57±7.16* 93.87±3.13* 对照组(n=50) 41.25±5.15 70.76±5.27 90.07±1.52 与对照组比较, *P < 0.05。
下载: 导出CSV
表 3 2组Harris评分优良率比较[n(%)]
组别 优 良 差 总优良 观察组(n=50) 41(82.00) 5(10.00) 4(8.00) 46(92.00)* 对照组(n=50) 27(54.00) 9(18.00) 14(28.00) 36(72.00) 与对照组比较, *P < 0.05。
下载: 导出CSV
表 4 2组患者术后并发症比较[n(%)]
组别 切口感染 肺部感染 下肢深静脉血栓 褥疮 螺钉切出 合计 观察组(n=50) 1(2.00) 1(2.00) 2(4.00) 0 0 4(8.00)* 对照组(n=50) 3(6.00) 4(8.00) 3(6.00) 1(2.00) 1(2.00) 12(24.00) 与对照组比较, *P < 0.05。
下载: 导出CSV
-
[1] 黄新, 陈姚飞, 李菊明, 等. 不同的手术方式对老年股骨转子间骨折的疗效研究[J]. 实用临床医药杂志, 2017, 21(23): 197-198. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL201723079.htm [2] 朱玉华. PFNA治疗老年股骨转子间骨折时螺旋刀片不同放置位置对临床疗效的影响[J]. 实用临床医药杂志, 2016, 20(23): 97-98, 104. doi: 10.7619/jcmp.201623030 [3] 赵成礼. 人工关节置换治疗老年股骨转子间骨折的优势与不足[J]. 中国组织工程研究, 2019, 23(24): 3868-3874. doi: 10.3969/j.issn.2095-4344.1221 [4] 曹军, 胡攀勇, 蔡保塔, 等. 三种植入物内固定治疗老年股骨转子间骨折的比较[J]. 中国组织工程研究, 2018, 22(11): 1683-1688. doi: 10.3969/j.issn.2095-4344.0163 [5] 孟庆奇, 崔树廷, 梁伟国, 等. DHS、PFNA、半髋关节置换术治疗老年不稳定性股骨转子间骨折的疗效对比[J]. 实用医学杂志, 2019, 35(7): 1036-1039, 1043. doi: 10.3969/j.issn.1006-5725.2019.07.006 [6] 陈健, 左才红, 张财义, 等. 解剖型髓内钉和股骨近端防旋髓内钉治疗老年股骨转子间骨折的疗效比较[J]. 北京大学学报: 医学版, 2019, 51(2): 283-287. https://www.cnki.com.cn/Article/CJFDTOTAL-BYDB201902016.htm [7] 黄伟彦, 彭杰威, 万明, 等. 股骨近端防旋髓内钉、锁定加压钢板、动力髋螺钉、Gamma钉4种内固定方式治疗老年股骨转子间骨折[J]. 中国组织工程研究, 2019, 23(12): 1846-1852. doi: 10.3969/j.issn.2095-4344.1122 [8] 董强, 张银光, 田维. 老年股骨转子间骨折手术固定方式[J]. 中国老年学杂志, 2018, 38(18): 4601-4603. doi: 10.3969/j.issn.1005-9202.2018.18.088 [9] 朱卫洁, 王晓芳, 申友亮, 等. 早期闭合复位PFNA内固定治疗老年股骨转子间骨折[J]. 中国矫形外科杂志, 2018, 26(6): 520-523. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXS201806012.htm [10] 徐驰, 周勇, 赵军, 等. PFNA治疗老年股骨转子间骨折的隐性失血分析[J]. 中国矫形外科杂志, 2018, 26(6): 510-515. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXS201806010.htm [11] 叶茂, 邹毅, 王明辉, 等. 高龄股骨转子间骨折保守治疗与四种手术治疗比较[J]. 中国矫形外科杂志, 2017, 25(22): 2032-2037. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXS201722005.htm [12] 张擎柱, 樊琪, 尹雪莲, 等. 三种植入物治疗老年脑梗死偏瘫侧股骨转子间骨折的比较[J]. 中国组织工程研究, 2019, 23(24): 3805-3811. doi: 10.3969/j.issn.2095-4344.1178 [13] 朱志军, 朱剑, 叶峥, 等. PFNA-Ⅱ主钉长度对A1、2型股骨转子间骨折患者临床疗效及安全性的影响[J]. 中国现代医学杂志, 2017, 27(26): 119-122. doi: 10.3969/j.issn.1005-8982.2017.26.025 [14] 夏涛. 双动半髋关节置换术与内固定术治疗老年股骨转子间骨折的中期疗效对比[J]. 实用临床医药杂志, 2018, 22(22): 52-55, 58. doi: 10.7619/jcmp.201822017 [15] 高飞, 周武, 谢卯, 等. PFNA联合规范化抗骨质疏松药物治疗老年骨质疏松性股骨转子间骨折[J]. 第二军医大学学报, 2017, 38(4): 437-442. https://www.cnki.com.cn/Article/CJFDTOTAL-DEJD201704008.htm [16] 刘永伟, 冯晓波, 谢卯, 等. PFNA与InterTan钉治疗老年股骨转子间不稳定性骨折临床疗效的比较: 一项前瞻性研究[J]. 第二军医大学学报, 2017, 38(4): 432-436. https://www.cnki.com.cn/Article/CJFDTOTAL-DEJD201704007.htm [17] 汪礼军, 杨秀江, 等. 两种术式治疗高龄不稳定股骨转子间骨折的临床效果研究[J]. 重庆医学, 2017, 46(1): 117-119. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX201701033.htm [18] 廉养杰. 股骨近端防旋髓内钉与股骨近端锁定钢板治疗老年股骨转子间骨折的疗效比较[J]. 实用临床医药杂志, 2019, 23(6): 103-106. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL201906028.htm
表(4)
计量
- 文章访问数: 217
- HTML全文浏览量: 123
- PDF下载量: 4
苏公网安备 32100302010246号
