摘要
目的:探讨防旋型股骨近端髓内钉(PFNA)内固定术对股骨粗隆间骨折患者生物力学性能的影响。方法:选取重庆市急救医疗中心2015年6月~2017年6月收治的股骨粗隆间骨折患者132例,根据患者的手术方式分成A组(n=66)与B组(n=66)。A组行PFNA内固定术,B组行人工髋关节置换术。比较两组围手术期指标,包括手术时间、术中出血量、卧床时间、术后引流量、住院时间、骨折愈合时间;采用Harris评分评价两组术前、术后6个月、术后12个月的关节功能恢复情况;分别在术后6个月、术后12个月比较两组生物力学特性,包括扭转1.5°时的扭转刚度与扭矩以及荷载800 N时的压缩刚度与压缩位移;并记录两组并发症发生率。结果:A组术中出血量小于B组,手术时间、卧床时间、住院时间及骨折愈合时间短于B组,差异有统计学意义(P<0.05)。两组术后6个月、术后12个月的Harris评分高于术前,且A组术后6个月的Harris评分高于B组,差异有统计学意义(P<0.05)。两组术后12个月扭转1.5°时扭转刚度、扭转1.5°时扭矩、荷载800 N时压缩刚度均高于术后6个月,荷载800 N时压缩位移小于术后6个月,且A组术后6个月扭转1.5°时扭转刚度、扭转15°时扭矩、荷载800 N时压缩刚度均高于B组,荷载800 N时压缩位移小于B组,差异有统计学意义(P<0.05)。A组和B组的并发症发生率分别为6.06%和9.09%,差异无统计学意义(P>0.05)。结论:与人工髋关节置换术相比,股骨粗隆间骨折患者行PFNA内固定术能取得更显著效果,可进一步促进术后机体功能恢复,改善术后6个月的生物力学性能,未增加并发症风险,临床推广价值更高。
Objective To investigate the effect of proximal femoral nail(PFNA)internal fixation on the biomechanical properties in patients with intertrochanteric fracture.Methods A total of 132 patients with intertrochanteric fracture who were admitted to Chongqing Emergency Medical Center from June 2015 to June 2017 were enrolled in the study and then divided into group A(n=66)and group B(n=66)according to the surgical procedure.PFNA internal fixation was adopted in group A,while artificial hip replacement was conducted in group B.The perioperative indicators of the two groups were compared,including operation time,intraoperative blood loss,bed rest time,postoperative drainage,hospitalization time and fracture healing time.Harris score was used to evaluate the recovery of joint functions in two groups before and at 6 months and 12 months after operation.Biomechanical properties,including the torsional stiffness and torque at 1.5°torsion as well as the compressive stiffness and displacement at 800 N load,were compared between two groups at 6 months and 12 months after operation.The incidences of complications in two groups were also recorded.Results The amount of intraoperative blood loss in group A was less than that in group B,and the operation time,bed rest time,hospitalization time and fracture healing time in group Awere shorter than those in group B(P<0.05).Harris scores at 6 months and 12 months after operation in both groups were higher than those before operation,and Harris scores in group A at 6 months after operation were higher than those in group B(P<0.05).The torsional stiffness and torque at 1.5°torsion and the compressive stiffness at 800 N load in both two groups at 12 months after operation were higher than those at 6 months after operation,and the compressive displacement at 800 N load was smaller than that at 6 months after operation.At 6 months after operation,the torsional stiffness and torque at 1.5°torsion and the compressive stiffness at 800 N load in group A were higher than those in group B,and the compressive displacement at 800 N load was smaller than that in group B,with statistical significance(P<0.05).No statistical significance was found in the incidence of complications which was 6.06%and 9.09%in group A and B,respectively(P>0.05).Conclusion Compared with artificial hip replacement,PFNA internal fixation for intertrochanteric fracture has higher clinical value for it can achieve more significant therapeutic outcomes,further promote the recovery of postoperative body function and improve the biomechanical properties at 6 months after surgery,without increasing the risk of complications.
作者
何苗
邓志龙
曹志东
刘健
张晓星
HE Miao;DENG Zhilong;CAO Zhidong;LIU Jian;ZHANG Xiaoxing(Department of Orthopedics,Chongqing Emergency Medical Center,Chongqing 400014,China)
出处
《中国医学物理学杂志》
CSCD
2019年第8期989-994,共6页
Chinese Journal of Medical Physics
基金
重庆市卫生计生委医学科研计划项目（2015HBRC014）
