摘要
目的分析股骨转子间骨折合并椎体压缩骨折行一期手术或分期手术治疗的效果的差异。方法回顾2018年6月至2020年6月湖南省脑科医院收治的股骨转子间骨折合并椎体压缩骨折患者。纳入标准:单侧肢体EvansⅠ~Ⅳ型股骨转子间骨折,受伤后24 h内行股骨近端防旋型髓内钉(PFNA)手术治疗,脊柱椎体Ⅰ~Ⅱ度压缩性骨折;排除标准:既往发生过髋部骨折,受伤前3个月内发生过脊柱椎体压缩性骨折,受伤前存在肢体全瘫或不全瘫,椎体爆裂性骨折,病理性骨折,累及2个或更多节椎体的压缩性骨折。根据患者实施脊柱椎体后凸成形术(PKP)的时机,分为2组。一期手术组:同台手术依次进行PFNA术、PKP术;分期手术组:首先施行PFNA术,PFNA术后3 d内限期行PKP术。分析患者的年龄、性别构成、术前背部疼痛视觉模拟评分法(VAS)评分和老年髋部骨折后的功能独立评分(FIM)评分,术后分析PFNA术耗时、PFNA术中出血量、术后6个月FIM评分、PKP术耗时、PKP术后背部疼痛VAS评分,并比较2组患者住院时长、住院总费用的差异。对于性别构成、基础疾病等计数资料,采用卡方检验或Fisher’s确切概率法比较;对于术前FIM评分、PFNA手术耗时、术后6个月FIM评分、住院总费用,行t检验;对于年龄、术前背部疼痛VAS评分、PFNA术中出血量、PKP术耗时、PKP术后背部疼痛VAS评分、住院时长,采用Mann-Whitney U秩和检验进行比较。结果本研究共纳入研究对象67例,一期手术组39例、分期手术组28例,2组患者的年龄[分别为69(66,74)岁、73(67,76)岁,Z=1.601]、性别比例(χ^(2)=2.975)、术前背部疼痛VAS评分[分别为4(2,4)、4(2,4),Z=-0.728]、术前FIM评分[分别为(61±5)、(59±5),t=1.506]基本一致,差异均无统计学意义(均为P>0.05)。一期手术组在PFNA术耗时(分别为(57.69±10.81)min、(62.54±12.69)min,t=-1.682)、PFNA术中出血量(分别为100.00(100.00,150.00)ml、100.00(50.00,100.00)ml,Z=-1.076)、术后6个月FIM评分[分别为(118.41±11.15)、(114.89±10.48),t=1.306]方面,与分期手术组患者的差异无统计学意义(均为P>0.05);施行PKP术所耗时间[分别为20.00(15.00,25.00)min、20.00(15.00,20.00)min,Z=-1.108]、PKP术后背部疼痛VAS评分[分别为0(0,1.00)、0(0,1.00),Z=-0.786]亦较相近,差异无统计学意义;但是一期手术组患者的住院时长更短[分别为7.00(6.00,7.00)d,11.00(9.50,12.50)d,Z=-6.280]、住院总费用较低[分别为(4.90±0.21)万元、(5.16±0.25)万元,t=-4.486],差异具有统计学意义(均为P<0.05)。结论对于股骨转子间骨折合并椎体压缩骨折患者,一期或分期手术行PFNA术、PKP术,术后恢复及疼痛改善情况基本一致,但一期手术可以降低住院时长、减少住院费用。
Objective To analyze the difference in the effect of one-stage operation or staged operation for intertrochanteric fracture complicated with vertebral compression fracture.Methods The patients with intertrochanteric fracture complicated with vertebral compression fracture admitted to Hunan Brain Hospital from June 2018 to June 2020 were reviewed.Inclusion criteria:unilateral EvansⅠ-Ⅳintertrochanteric fracture of the limb,proximal femoral anti-rotation intramedullary nail(PFNA)surgery within 24 h after injury,Ⅰ-Ⅱdegree compression fracture of the vertebral body.Exclusion criteria:previous hip fracture,spinal vertebral compression fracture within three months prior to injury,total or incomplete limb palsy prior to injury,vertebral burst fracture,pathological fracture,and compression fracture involving two or more vertebrae.According to the timing of spinal kyphoplasty(PKP),the patients were divided into two groups.One-stage operation group:PFNA and PKP were performed successively at the same stage;staged operation group:PFNA was performed first,and PKP was performed within three days after PFNA.Age,gender composition,visual analogue scale(VAS)score for preoperative back pain and functional independent score(FIM)score for elderly hip fracture were analyzed.Postoperative PFNA duration,PFNA intraoperative blood loss,postoperative six months FIM score,PKP duration,and VAS score for PKP postoperative back pain were analyzed.The length of hospitalization and total hospitalization cost were compared between the two groups.Chi-square test or Fisher′s exact test were used to compare the counting data such as gender ratio and previous diseases;t test was performed to analyze preoperative FIM score,time-consuming on PFNA procedure,six-month postoperative FIM score,and total cost of hospitalization;Mann-Whitney U test was used for comparison for the age,VAS scores of preoperative back pain,intraoperative blood loss of PFNA,the duration and VAS scores of postoperative back pain of PKP,and length of hospital stay.Results A total of 67 patients were included in this study,including 39 patients in the primary surgery group and 28 patients in the staged surgery group.The age of patients in the two groups[69(66,74)years,73(67,76)years,Z=1.601],the sex ratio(χ^(2)=2.975),preoperative back pain VAS scores[4(2,4),4(2,4),Z=-0.728],preoperative FIM scores[(61±5),(59±5),t=1.506]were basically the same.There was no significant difference(P>0.05).PFNA operation time(57.69±10.81)min,(62.54±12.69)min,t=-1.682),intraoperative PFNA blood loss[100.00(100.00,150.00)ml,100.00(50.00,100.00)ml,Z=-1.076],FIM score six months after operation[(118.41±11.15),(114.89±10.48),t=1.306],there was no statistically significant difference between the patients and the staging operation group(P>0.05).The duration of PKP operation[20.00(15.00,25.00)min,20.00(15.00,20.00)min,Z=-1.108]and the VAS score of back pain after PKP operation[0(0,1.00),0(0,1.00),Z=-0.786]showed no statistically significant difference.The patients in the primary surgery group had shorter length of hospital stay[7.00(6.00,7.00)d,11.00(9.50,12.50)d,Z=-6.280]and lower total hospitalization cost[(4.90±0.21)ten thousand CNY,(5.16±0.25)ten thousand CNY,t=-4.486].The differences were statistically significant(all P<0.05).Conclusion For patients with intertrochanteric fractures of femur combined with vertebral compression fractures,PFNA and PKP are similar in postoperative recovery and pain improvement by one-stage or staged operations,but the length of hospital stay and hospitalization cost can be reduced by staged operation.
作者
李奇伟
林涨源
Li Qiwei;Lin Zhangyuan(Department of Hand and Foot Surgery, Hunan Brain Hospital (Hunan Second People′s Hospital), Changsha 417000, China;Department of Osteology, Xiangya Hospital, Central South University, Changsha 410013, China)
出处
《中华关节外科杂志（电子版）》
CAS
CSCD
2021年第5期528-532,共5页
Chinese Journal of Joint Surgery(Electronic Edition)
关键词
髋骨折
脊柱骨折
椎体
内固定器
Hip fractures
Spinal Fractures
Vertebral body
Internal fixators
