THA与内固定术联合功能训练对股骨粗隆间骨折的疗效比较
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摘要
目的探讨人工髋关节置换术(THA)与内固定术联合功能训练对老年股骨粗隆间骨折患者的影响。方法回顾性分析120例老年股骨粗隆间骨折患者临床资料,根据手术方法不同分为A组(n=62)与B组(n=58)。A组应用THA治疗,B组应用内固定术治疗,术后均行康复功能训练。比较两组围手术期指标水平、骨折愈合时间及术后并发症发生率;在术前和术后3个月,评估两组生活质量,检测血清炎症因子水平;在术前和术后3、6个月,评估两组髋关节功能。结果 (1)A组手术时间、术中出血量以及卧床、住院、骨折愈合时间均少于B组(P <0.05);(2)术后3个月时,两组SF-36评分均高于术前(P <0.05),两组血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和IL-10水平均低于术前(P <0.05),且A组改善幅度均大于B组(P <0.05);(3)术后3个月、6个月时,两组Harris评分均大于术前(P <0.05),其中术后3个月时A组大于B组(P <0.05),而术后6月时,两组无统计学差异(P> 0.05);两组术后并发症发生率无统计学差异(P> 0.05)。结论 THA能改善老年股骨粗隆间骨折患者围手术期状况,有利于骨折愈合,改善患者早期髋关节功能和生活质量。
Objective To explore the effect of total hip arthroplasty(THA) combined with internal fixation on senile patients with intertrochanteric fracture of femur(IFF). Methods The clinical data of 120 senile patients with IFF were retrospectively analyzed.They were divided into group A(n=62) and group B(n=58) according to different surgical methods. Group A was treated with THA and group B with internal fixation. All patients received rehabilitation training after the operation. The perioperative index level,fracture healing time and the incidence of complications were compared between the two groups; the quality of life and the level of serum inflammatory factors were assessed before and three and six months after the operation; the hip joint functions in the two groups were evaluated before and three and six months after the operation. Results(1) The operation time, intraoperative bleeding volume,bed rest period, hospitalization period and fracture healing time in group A were less than those in group B(P < 0.05).(2) Three months after the operation, the SF-36 scores in both groups were higher than those before the operation(P < 0.05), the serum levels of tumor necrosis factor-α(TNF-α), interleukin-6(IL-6) and interleukin-10(IL-10) in both groups were lower than those before the operation(P < 0.05), and the improvement in group A was higher than that in group B(P < 0.05).(3) Three and six months after the operation, the Harris scores of the two groups were higher than those before the operation(P < 0.05). Three months after the operation,the Harris scores of group A were higher than those of group B(P < 0.05), while six months after the operation, there was no significant difference between the two groups(P > 0.05), and there was no significant difference in the incidence of complications between the two groups(P > 0.05). Conclusion THA can improve the perioperative condition of senile patients with IFF, facilitate fracture healing and improve the early hip function and quality of life of patients.
Objective To explore the effect of total hip arthroplasty(THA) combined with internal fixation on senile patients with intertrochanteric fracture of femur(IFF). Methods The clinical data of 120 senile patients with IFF were retrospectively analyzed.They were divided into group A(n=62) and group B(n=58) according to different surgical methods. Group A was treated with THA and group B with internal fixation. All patients received rehabilitation training after the operation. The perioperative index level,fracture healing time and the incidence of complications were compared between the two groups; the quality of life and the level of serum inflammatory factors were assessed before and three and six months after the operation; the hip joint functions in the two groups were evaluated before and three and six months after the operation. Results(1) The operation time, intraoperative bleeding volume,bed rest period, hospitalization period and fracture healing time in group A were less than those in group B(P < 0.05).(2) Three months after the operation, the SF-36 scores in both groups were higher than those before the operation(P < 0.05), the serum levels of tumor necrosis factor-α(TNF-α), interleukin-6(IL-6) and interleukin-10(IL-10) in both groups were lower than those before the operation(P < 0.05), and the improvement in group A was higher than that in group B(P < 0.05).(3) Three and six months after the operation, the Harris scores of the two groups were higher than those before the operation(P < 0.05). Three months after the operation,the Harris scores of group A were higher than those of group B(P < 0.05), while six months after the operation, there was no significant difference between the two groups(P > 0.05), and there was no significant difference in the incidence of complications between the two groups(P > 0.05). Conclusion THA can improve the perioperative condition of senile patients with IFF, facilitate fracture healing and improve the early hip function and quality of life of patients.
引文
[1]周伟,吕莉慧,黄莹,等.人工髋关节置换术与功能训练对老年股骨粗隆间骨折患者术后康复的效果研究[J].现代生物医学进展,2016,16(34):6691-6693.
[2]雷飞跃,张雪平.内固定术与人工髋关节置换术治疗老年股骨粗隆间骨折的疗效对比[J].中国骨与关节损伤杂志,2016,31(4):405-406.
[3]王立刚,陈晓东,朱俊峰,等.老年人股骨粗隆间骨折的治疗进展[J].临床与病理杂志, 2016, 36(5):695-701.
[4]闫丹舟.PFNA与PFN内固定治疗老年股骨粗隆间骨折手术指标、血液相关指标及髋关节Harris评分的对比观察[J].临床和实验医学杂志,2016,15(21):2105-2107.
[5]丁庆彬,季艳萍,吴怀兰.骨质疏松性髋部骨折术后患者心理弹性与生活质量的相关性[J].中华现代护理杂志, 2016(4):510-513.
[6]杨琳,李琦,王馨曼,等.基于GRADE系统的临床护理路径应用于髋关节置换病人手术前后功能锻炼的系统评价[J].护理研究,2016,30(22):2728-2735.
[7]贺红梅,安帅,张新玉,等.老年股骨粗隆间骨折术后早期强化功能锻炼的对比研究[J].北京医学,2017,39(2):150-153.
[8]杨国强,郭岩凤.生物型假体加捆绑治疗老年股骨粗隆间骨折对机体炎症因子的影响[J].生物骨科材料与临床研究,2016,13(3):52-55.
[2]雷飞跃,张雪平.内固定术与人工髋关节置换术治疗老年股骨粗隆间骨折的疗效对比[J].中国骨与关节损伤杂志,2016,31(4):405-406.
[3]王立刚,陈晓东,朱俊峰,等.老年人股骨粗隆间骨折的治疗进展[J].临床与病理杂志, 2016, 36(5):695-701.
[4]闫丹舟.PFNA与PFN内固定治疗老年股骨粗隆间骨折手术指标、血液相关指标及髋关节Harris评分的对比观察[J].临床和实验医学杂志,2016,15(21):2105-2107.
[5]丁庆彬,季艳萍,吴怀兰.骨质疏松性髋部骨折术后患者心理弹性与生活质量的相关性[J].中华现代护理杂志, 2016(4):510-513.
[6]杨琳,李琦,王馨曼,等.基于GRADE系统的临床护理路径应用于髋关节置换病人手术前后功能锻炼的系统评价[J].护理研究,2016,30(22):2728-2735.
[7]贺红梅,安帅,张新玉,等.老年股骨粗隆间骨折术后早期强化功能锻炼的对比研究[J].北京医学,2017,39(2):150-153.
[8]杨国强,郭岩凤.生物型假体加捆绑治疗老年股骨粗隆间骨折对机体炎症因子的影响[J].生物骨科材料与临床研究,2016,13(3):52-55.