摘要
目的探讨亚洲型股骨近端防旋髓内钉(PFNAⅡ)治疗股骨转子间骨折的效果及术后凝血功能变化、髋关节功能的恢复效果。方法前瞻性选择2014年4月—2019年2月中核404医院骨科采取手术治疗的100例股骨转子间骨折患者,采用随机数字表分为PFNAⅡ组、DHS组各50例,PFNAⅡ组采用PFNAⅡ治疗,DHS组采用动力髋螺钉(DHS)治疗。对比两组手术时间、术中出血量、切口长度、术后住院时间、骨折愈合时间、手术前后两组患者的血红蛋白(Hb)、红细胞压积(Hct)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、D-二聚体、血栓弹力图参数凝血反应时间(R值)、凝血形成时间(K值)、血凝块形成速率或α角(α角)和Harris评分。结果PFNAⅡ组患者的手术时间(83.0±10.4)min、术中出血量(114.9±21.0)mL、切口长度(6.2±1.8)cm均少于DHS组(104.9±17.3)min、(158.0±30.7)mL、(9.4±2.1)cm,差异有统计学意义(P<0.05),PFNAⅡ组患者的术后住院时间、骨折愈合时间与DHS组比较差异无统计学意义(P>0.05);术前,PFNAⅡ组和DHS组患者的Hb、Hct、TT、APTT、PT、D-D差异无统计学意义(P>0.05);术后3d复查,PFNAⅡ组患者的Hb(123.8±8.4)g/L、Hct(38.3±3.4)%、TT(18.2±1.1)s、APTT(32.2±1.9)s、PT(12.4±0.9)s高于DHS组Hb(118.7±9.1)g/L、Hct(36.5±2.8)%、TT(17.3±1.0)s、APTT(31.1±2.0)s、PT(11.8±1.0)s,差异有统计学意义(P<0.05),PFNAⅡ组患者的D-D值(0.4±0.2)mg/L低于DHS组(0.6±0.2)mg/L(P<0.05);术后3d复查两组患者的血栓弹力图参数,PFNAⅡ组患者的R值(4.9±0.6)min高于DHS组(4.6±0.4)min,差异有统计学意义(P<0.05),PFNAⅡ组患者的α角(68.1±5.7)°小于DHS组(71.5±6.0)°,差异有统计学意义(P<0.05);术后3、6个月PFNAⅡ组和DHS组患者的Harris评分差异无统计学意义(P>0.05)。结论PFNAⅡ治疗股骨转子间骨折较DHS具有手术创伤更小、术后患者隐性失血更少、对患者凝血功能的影响更小的优势。
Objective To investigate the effect of Asian proximal femoral anti-rotational intramedullary nail(PFNAⅡ)in the treatment of femoral intertrochanteric fractures,the changes of postoperative coagulation function,and the recovery of hip joint function.Methods A prospective study was performed on 100 patients with intertrochanteric fractures who were treated in Department of Orthopaedics,China Nuclear 404 Hospital from Apr.2014 to Feb.2019.Patients were randomly divided into the PFNAⅡgroup and dynamic hip screw(DHS)group with 50 cases in each.The operation time,intraoperative bleeding,incision length,postoperative hospital stay,fracture healing time,hemoglobin(Hb),hematocrit(Hct),and thrombin time(TT),activated partial thromboplastin time(APTT),prothrombin time(PT),D-dimer,thromboelastogram parameters such as coagulation reaction time(R value),coagulation formation time(K value),blood clot formation rate orαangle(αangle)and Harris score were compared between the two groups.Results The operation time(83.0±10.4)minutes,intraoperative blood loss(114.9±21.0)mL,and the length(6.2±1.8)cm of the PFNAⅡgroup were all less than those in the DHS group[(104.9±17.3)minutes,(158.0±30.7)mL,(9.4±2.1)cm],and the differences were statistically significant(P<0.05).There was no significant difference in postoperative hospital stay and fracture healing time between the PFNAⅡgroup and the DHS group(P>0.05).Before operation,there was no statistically significant difference in Hb,Hct,TT,APTT,PT,D-D between the PFNAⅡgroup and the DHS group(P>0.05);at 3 days after operation,the Hb of the PFNAⅡgroup was(123.8±8.4)g/L,Hct(38.3±3.4)%,TT(18.2±1.1)s,APTT(32.2±1.9)s,PT(12.4±0.9)s,which were all higher than those in the DHS group[Hb(118.7±9.1)g/L,Hct(36.5±2.8)%,TT(17.3±1.0)s,APTT(31.1±2.0)s,PT(11.8±1.0)s],and the differences were statistically significant(P<0.05).The D-D value of patients in the PFNAⅡgroup(0.4±0.2)mg/L was lower than that of the DHS group(0.6±0.2)mg/L(P<0.05);the thromboelastogram parameters of the
作者
张金海
杨正帅
张斌
Zhang Jinhai;Yang Zhengshuai;Zhang Bin(Department of Orthopaedics,940 Hospital of the PLA Joint Logistics Support Force(formerly the General Hospital of Lanzhou Military Region),Lanzhou 730050,China;Department of Orthopaedics,China Nuclear 404 Hospital,Jiayuguan,Gansu 735100,China)
出处
《创伤外科杂志》
2021年第3期199-204,共6页
Journal of Traumatic Surgery
关键词
股骨转子间骨折
股骨近端防旋髓内钉
凝血功能
髋关节功能
intertrochanteric fracture
proximal femoral anti-rotation intramedullary nail
coagulation function
hip function
