摘要
目的比较分析伽玛(γ)髓内钉与人工股骨头置换术治疗高龄骨质疏松性股骨粗隆间骨折的治疗效果。方法选取2018年1月至2020年12月青岛市黄岛区中心医院骨科收治的68例高龄骨质疏松性股骨粗隆间骨折患者。男30例,女38例;年龄(79.93±2.94)岁,年龄范围为75~92岁。根据手术方式将患者分为伽玛(γ)钉组和置换组,每组34例。比较两组患者的手术相关指标,包括切口长度、手术时间、术中出血量、术后下床活动时间、住院时间。术后观察患者的并发症发生情况,并进行Harris髋关节评分。结果伽玛(γ)钉组切口长度[(4.17±1.30)cm]小于置换组[(10.33±2.57)cm],手术时间[(75.41±9.73)min]短于置换组[(83.10±11.48)min],术中出血量[(209.14±28.79)ml]少于置换组[(319.52±52.65)ml],但术后下床活动时间[(9.94±2.61)d]晚于置换组[(4.46±1.39)d],差异均有统计学意义(P<0.05);术后1个月、术后3个月置换组Harris评分[(48.90±9.24)分、(75.41±12.43)分]高于伽玛(γ)钉组[(34.53±7.76)分、(69.83±8.36)分],差异有统计学意义(P<0.05);置换组手术并发症发生率[5.9%(2/34)]低于伽玛(γ)钉组[26.5%(9/34)],差异有统计学意义(P<0.05)。结论伽玛(γ)髓内钉与人工股骨头置换术均能有效治疗高龄骨质疏松性股骨粗隆间骨折,人工股骨头置换术有利于促进患者早期功能恢复,手术并发症发生率低,但相对手术创伤较大。伽玛(γ)髓内钉的远期治疗效果与人工股骨头置换术相当,其手术创伤更小、手术时间更短、术中出血量更少,可作为一种治疗方案应用于临床。
Objective To compare the curative effect of gamma(γ)intramedullary nail and artificial femoral head replacement in the treatment of elderly osteoporotic intertrochanteric fracture.Methods A total of 68 elderly patients with osteoporotic intertrochanteric fracture who were admitted to department of Orthopedics,Huangdao District Central Hospital from January 2018 to December 2020.Patients were divided into the gamma(γ)nail group and replacement group according to the surgical method,34 patients in each group.The perioperative indexes of the two groups were compared,including incision length,operation time,intraoperative blood loss,postoperative ambulation time and hospital stay.The patients were followed up,the incidence of postoperative complications was recorded and compared,the postoperative imaging results were observed,the Harris hip score and the functional recovery of the affected hip were evaluated and compared.Results The incision length of the gamma(γ)nail group[(4.17±1.30)cm]was significantly shorter than that of the replacement group[(10.33±2.57)cm],the operation time in the gamma(γ)nail group[(75.41±9.73)minutes]was significantly shorter than that of the replacement group[(83.10±11.48)minutes],the intraoperative bleeding volume in the gamma(γ)nail group[(209.14±28.79)ml]was significantly less than that of the replacement group[(319.52±52.65)ml],but the time of getting out of bed after operation in the gamma(γ)nail group[(9.94±2.61)days]was significantly longer than that of the replacement group[(4.46±1.39)days],and the difference was statistically significant(P<0.05).The Harris scores of the replacement group[(48.90±9.24)points and(75.41±12.43)points]were significantly higher than those of the gamma(γ)nail group[(34.53±7.76)points and(69.83±8.36)points]at 1 and 3 months postoperatively(P<0.05).The incidence of surgical complications in the replacement group(5.9%)was significantly lower than that in the gamma(γ)nail group(26.5%),and the difference was statistically significant(P<0.05).Conclusion Gamma(γ)intramedullary nail and artificial femoral head replacement can effectively treat osteoporotic femoral intertrochanteric fracture in the elderly,artificial femoral head replacement can promote early functional recovery of patients with low incidence of surgical complications,but it is relatively traumatic.The long-term effect of gamma(γ)intramedullary nail is similar to that of artificial femoral head replacement.It has less trauma,shorter operation time and less bleeding.It is also used as a therapeutic scheme in clinic.
作者
郭道瑞
丁飞
屈铁男
陈洪瑜
Guo Daorui;Ding Fei;Qu Tienan;Chen Hongyu(Department of Orthopedics,Huangdao District Central Hospital,Qingdao 266555,China)
出处
《中国临床实用医学》
2021年第1期52-56,共5页
China Clinical Practical Medicine
关键词
股骨粗隆间骨折
骨质疏松
高龄患者
人工股骨头置换术
伽玛(γ)髓内钉
内固定
Femoral intertrochanteric fracture
Osteoporosis
Elderly patients
Artificial femoral head replacement
Gamma(γ)intramedullary nail
Internal fixation
