摘要
目的对比老年髋部骨折患者采用人工关节置换术或股骨近端髓内钉-螺旋刀片内固定治疗的疗效差异。方法前瞻性分析2015年5月-2017年5月河北省沧州市人民医院骨科收治的125例老年髋部骨折患者,根据随机数字表法将其分为内固定组(n=65)和关节置换组(n=60)。内固定组接受股骨近端髓内钉-螺旋刀片内固定治疗,关节置换组接受人工关节置换术治疗。比较两组患者术中出血量、术后负重时间、并发症发生率、关节功能以及骨γ-羧基谷氨酸蛋白(BGP)、甲状旁腺激素(PTH)、骨碱性磷酸酶(BALP)水平。同时,采用Tecnobody PK254P平衡康复系统评估两组前后标准差(SD)、运动长度及运动面积以及压力中心(COP)相关参数XCOP、YCOP及左右SD、前后运动速度、左右运动速度。结果关节置换组并发症如关节/伤口感染,内置物松动,心血管疾病,肺部、尿道感染总发生率为6.67%,低于内固定组的20.00%(P<0.05)。术后6、12个月关节置换组的髋关节功能优良率均高于内固定组(P<0.05)。术后12个月两组患者BGP、PTH、BALP水平均高于术前,且关节置换组高于内固定组(P<0.05)。关节置换组患者前后标准差(SD)、运动长度及运动面积均大于内固定组(P<0.05),但两组患者压力中心(COP)相关参数XCOP、YCOP及左右SD、前后运动速度、左右运动速度比较差异无统计学意义(P>0.05)。结论股骨近端髓内钉-螺旋刀片内固定治疗老年髋部骨折患者的出血量较少、术后平衡能力较好;人工关节置换术治疗老年髋部骨折患者康复较快,并发症发生率较低。两者各具优势,医师应根据临床实际选择合适的术式。
Objective To compare the therapeutic effect of proximal intramedullary nail-screw blade internal fixation and artificial joint replacement in elderly patients with hip fracture.Methods Totally 125 elderly patients with hip fracture who were admitted to our hospital from May 2015 to May 2017 were selected.They were divided into internal fixation group(n=65) and joint replacement group(n=60) according to random number table method.The internal fixation group was treated with proximal intramedullary nail-screw blade internal fixation,and the joint replacement group was treated with artificial joint replacement.The bleeding volume,postoperative weight-bearing time,complication rate,joint function,levels of bone gamma-carboxyglutamic-acid-containing proteins(BGP),parathyroid hormone(PTH) and bone alkaline phosphatase(BALP) of the two groups were compared. Meanwhile,standard deviation(SD),COP related parameters such as XCOP,YCOP,SD and forward and backward motor speed and the left and right motor speed were compared.Results Compared with the internal fixation group,the intraoperative blood loss in the joint replacement group was higher,and the postoperative weight-bearing time was earlier(P<0.05).The incidence of complications in the joint replacement group was 6.67%,which was lower than 20.00% in the internal fixation group(P<0.05).The excellent and good rate of hip joint function in the joint replacement group was higher than that in the internal fixation group at 6 and 12 months after operation(P<0.05).The levels of BGP,PTH,BALP were higher in the two groups at 12 months after operation than those before operation,and the joint replacement group was higher than the internal fixation group(P<0.05).The SD,movement length and motor area of the joint replacement group were higher than those of the internal fixation group(P<0.05).However,there was no significant difference in the parameters of COP between the two groups,such as XCOP,YCOP,left and right SD,forward and backward motor speed,left and right motor speed(P>0.05
作者
金忠军
沈朝
刘贝妮
刘树江
郝玉升
JIN Zhong-jun;SHEN Zhao;LIU Bei-ni;LIU Shu-jiang;HAO Yu-sheng(Department of Orthopedics,Cangzhou People s Hospital Cangzhou,Hebei 061000,China;Department of Endocrinology,Cangzhou People s Hospital,Cangzhou,Hebei,061000 China)
出处
《创伤外科杂志》
2020年第2期133-137,共5页
Journal of Traumatic Surgery
基金
河北省沧州市科技计划项目(151302078)
关键词
髋部骨折
关节置换
髓内钉
内固定
老年
hip fracture
joint replacement
intramedullary nail
internal fixation
elderly
