| 王汉邦,仇汪宝,梁 伟,李 令,史保庆.不同内固定治疗老年不稳定股骨粗隆间骨折患者的近远期疗效及并发症对比[J].,2024,(16):3152-3156 |
| 不同内固定治疗老年不稳定股骨粗隆间骨折患者的近远期疗效及并发症对比 |
| Comparison of Short-term and Long-term Efficacy and Complications of Different internal Fixation Methods in the Treatment of Elderly Patients with Unstable Intertrochanteric Fracture of Femur |
| 投稿时间：2024-02-03 修订日期：2024-02-27 |
| DOI：10.13241/j.cnki.pmb.2024.16.030 |
| 中文关键词: 内固定 股骨近端防旋髓内钉 锁定钢板 老年 不稳定股骨粗隆间骨折 疗效 并发症 |
| 英文关键词: Internal fixation Proximal femoral nail anti-rotation Locking plate Elderly Unstable intertrochanteric fracture of femur Efficacy Complications |
| 基金项目:安徽省高校科研重点项目（2023AH050681） |
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| 中文摘要: |
| 摘要 目的：分析不同内固定治疗老年不稳定股骨粗隆间骨折（IFF）患者的近远期疗效及并发症。方法：选择了我院在2020年1月至2023年1月期间收治的60名老年不稳定IFF患者作为研究样本，根据不同的手术方法将其分为两组，PF-LCP组30名（接受PF-LCP手术）和PFNA组30名（接受PFNA内固定手术）。比较两组患者的手术情况、髋关节功能（HHS）、骨代谢指标和炎症因子水平[I型前胶原氨基端前肽（PINP）、I型胶原交联羧基末端肽（CTX）、血清白介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）]、生活质量以及并发症发生情况。结果：PFNA组手术时长、住院天数和骨折愈合时间均短于PF-LCP组，术中出血量少于PF-LCP组（P＜0.05）；两组术后3、6、12个月的HHS评分均较术前逐渐升高，PFNA组术后3、6个月的HHS评分高于PF-LCP组（P<0.05），两组术后12个月的HHS评分比较无显著性差异（P>0.05）；两组术后6个月的PINP水平均较前升高，且PFNA组高于PF-LCP组（P<0.05），CTX、IL-6、TNF-α水平均较前降低，且PFNA组低于PF-LCP组（P<0.05）；术后12个月，两组患者生活质量评分均较前升高，且PFNA组高于PF-LCP组（P<0.05）；随访12个月，PFNA组内固定失败4例（包括主钉断裂3例，螺旋刀片退钉1例），失败率13.33%，PF-LCP组无内固定失败病例，PFNA组内固定失败率高于对照组（P<0.05）；两组其他术后并发症总发生率比较无明显差异（P>0.05）。结论：PFNA与PF-LCP均能有效治疗老年不稳定IFF，相较于PF-LCP，PFNA治疗患者术后恢复更快且近期疗效更佳，但患者内固定失败风险相对更大。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the short-term and long-term efficacy and complications of different internal fixation in the treatment of elderly patients with unstable intertrochanteric fracture of femur (IFF). Methods: 60 elderly patients with unstable IFF admitted to our hospital from January 2020 to January 2023 were selected as research samples. According to different surgical methods, they were divided into two groups, including 30 cases in PF-LCP group (receiving PF-LCP surgery) and 30 cases in PFNA group (receiving PFNA internal fixation surgery). The surgical conditions, hip function (HHS), bone metabolism indexes and inflammatory factors levels [type I procollagen amino terminal peptide (PINP), type I collagen carboxy terminal peptide (CTX), serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α)], quality of life and complications were compared between the two groups. Results: The surgical time, hospital stay and fracture healing time in the PFNA group were shorter than those in PF-LCP group, and the intraoperative blood loss was less (P<0.05). The HHS score of the two groups at 3 months, 6 months and 12 months after surgery was gradually higher than that before surgery, and the HHS scores in the PFNA group at 3 months and 6 months after surgery were higher than those in the PF-LCP group (P<0.05). There was no significant difference in HHS score between the two groups at 12 months after surgery(P>0.05). The PINP level in the two groups at 6 months after surgery was higher than that before surgery, and the PFNA group had higher PINP level than the PF-LCP group (P<0.05). The levels of CTX, IL-6 and TNF-?琢 were reduced than those before surgery, and the levels in the PFNA group were lower (P<0.05). At 12 months after surgery, the quality of life scores of the two groups were higher than before surgery, and the PFNA group had higher scores than the PF-LCP group (P<0.05). After 12 months of follow-up, there were 4 cases of internal fixation failure in PFNA group (including 3 cases of main nail fracture and 1 case of screw blade withdrawal), and the failure rate was 13.33%. There was no case of internal fixation failure in PF-LCP group, and the failure rate of internal fixation in PFNA group was higher than that in control group (P<0.05). There was no significant difference in the total incidence of other postoperative complications between the two groups(P>0.05). Conclusion: Both PFNA and PF-LCP can effectively treat unstable IFF in the elderly. Compared with PF-LCP, PFNA has faster postoperative recovery and better short-term efficacy, but the risk of internal fixation failure is relatively greater. |
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