摘要
目的观察股骨近端髓内钉固定治疗高龄股骨粗隆间骨折的临床效果及对患者疼痛程度(VAS)评分的影响。方法选取2017年1-12月杭州市大江东医院收治的高龄股骨粗隆间骨折患者49例作为研究对象,按内固定方式分为两组,股骨近端解剖锁定钢板(PFLP)组25例给予股骨近端锁定钢板,股骨近端防旋髓内钉(PFNA)组24例给予股骨近端髓内钉微创治疗,对比两组治疗效果,并观察患者VAS评分变化情况。结果PFNA组手术时间(101.33±39.41)min、术中出血量(261.08±184.98)mL、切口长度(7.66±3.04)cm、负重时间(5.58±1.47)周、骨折愈合时间(16.66±2.03)周,均显著优于PFLP组的(137.36±43.65)min、(456.40±148.18)mL、(14.76±1.76)cm、(11.4±1.44)周、(19.36±3.49)周(t=3.184、4.085、10.024、13.963、3.274,均P<0.05)。而PFNA组术后1个月VAS评分(6.56±2.87)分、3个月VAS评分(5.87±1.25)分、6个月VAS评分(2.62±0.98)分,均优于PFLP组(t=4.855、7.545、8.541,均P<0.05);治疗后,PFNA组肿瘤坏死因子α、白细胞介素6、C反应蛋白水平分别为(22.39±1.85)ng/L、(120.54±5.24)ng/L、(7.79±2.25)mg/L,明显优于PFLP组的(33.69±2.25)ng/L、(154.25±5.52)ng/L、(13.96±3.25)mg/L(t=5.287、4.987、5.124,均P<0.05)。结论在治疗股骨粗隆间骨折时,选择PFNA内固定时可缩短手术时间,减少术中出血量,具有小切口微创固定的效果,术后可早期下床功能锻炼促进骨折愈合,并发症少。
Objective To explore the clinical effect of proximal femoral nailing in the treatment of intertrochanteric fracture of the femur and its effect on patients' VAS score. Methods From January 2017 to December 2017, 49 elderly patients with intertrochanteric fracture in Hangzhou Dajiangdong Hospital were selected in the research.According to internal fixation methods, the patients were divided into two groups.The PFLP group(25 cases) received proximal femoral locking plate, the PFNA group (24 cases) received proximal femoral intramedullary nail by minimally invasive treatment.The therapeutic effect was compared between the two groups. Results The operating time, intraoperative blood loss, incision length, the weight bearing time, fracture healing time in the PFNA group were (101.33±39.41)min,(261.08±184.98)mL,(7.66±3.04)cm,(5.58±1.47) weeks,(16.66±2.03) weeks, respectively, which were significantly better than those in the PFLP group [(137.36±43.65)min,(456.40±148.18)mL,(14.76±1.76)cm,(11.4±1.44)weeks,(19.36±3.49)weeks](t=3.184, 4.085, 10.024, 4.085, 10.024, all P<0.05). At 1, 3, 6 months after operation, the VAS scores of the PFNA group were (6.56±2.87)points,(5.87±1.25)points and (2.62±0.98)points, which were better than those of the PFLP group (t=4.855, 7.545, 8.541, all P<0.05). After treatment, the INF-alpha, IL-6, CRP levels in the PFNA group were (22.39±1.85)ng/L,(120.54±5.24)ng/L,(7.79±2.25)mg/L, respectively, which were significantly lower than those in the PFLP group [(33.69±2.25)ng/L,(154.25±5.52)ng/L,(13.96±3.25)mg/L](t=5.287, 4.987, 5.124, all P<0.05). Conclusion In the treatment of intertrochanteric fracture, PFNA internal fixation has shorter operation time, less intraoperative blood loss, small incision and minimally invasive fixation, and can get out of bed early after operation, functional exercise can promote fracture healing.It has fewer complications and high clinical value.
作者
曹娴华
Cao Xianhua(Department of Orthopedics, Hangzhou Dajiangdong Hospital, Hangzhou, Zhejiang 311225, China)
出处
《中国基层医药》
CAS
2019年第9期1057-1061,共5页
Chinese Journal of Primary Medicine and Pharmacy
