InterTan髓内钉联合股方肌蒂骨瓣移植治疗老年髋部骨折的临床研究  

InterTan intramedullary nail internal fixation combined with quadratus femoris muscle pedicle bone flap grafting as a treatment in elderly patients with hip fractures:a clinical study

作　　者：陆辉[1] 施俊峰[1] Lu Hui;Shi Junfeng(Department of Orthopedics,Nantong Third People’s Hospital,Nantong,Jiangsu 226000,China)

机构地区：[1]南通市第三人民医院骨科,江苏南通226000

出　　处：《中华生物医学工程杂志》2021年第1期41-46,共6页Chinese Journal of Biomedical Engineering

摘　　要：目的:探讨InterTan髓内钉联合股方肌蒂骨瓣移植治疗老年髋部骨折的疗效及其对血清B型尿钠肽(BNP)、纤维蛋白原(FIB)和1型前胶原氨基末端前肽(P1NP)水平的影响。方法:收集2016年1月至2018年12月本院就诊的老年髋部骨折患者78例,均为股骨颈骨折。随机数字表法分为对照组和观察组,各39例。对照组行空心螺钉内固定治疗,观察组行InterTan髓内钉联合股方肌蒂骨瓣移植治疗。比较两组的治疗效果及治疗前后血清BNP、FIB和P1NP水平。结果:对照组手术时间、切口长度、术中出血量、住院时间和骨折愈合时间均显著优于观察组(均P<0.05)。观察组和对照组治疗优良率分别为84.62%(33/39)、61.54%(24/39),观察组显著高于对照组(χ2=5.278,P<0.05)。与术前比较,术后1个月、6个月和12个月两组视觉模拟评分(VAS)均显著降低,日常生活活动能力(ADL)评分均显著升高(均P<0.05);且随着时间延长,两组术后VAS评分逐渐降低,ADL评分逐渐升高。术后1个月、6个月和12个月,观察组ADL评分均显著高于对照组(均P<0.05)。术前及术后各时点两组VAS评分比较,差异均无统计学意义(均P>0.05)。观察组和对照组术后并发症总发生率分别为15.38%(6/39)、38.46%(15/39),观察组显著低于对照组(χ2=5.278,P<0.05)。术后24 h、48 h、72 h两组血清BNP、FIB水平较术前均显著升高(均P<0.05),且术后不同时点血清BNP和FIB水平均呈逐渐升高趋势;术后不同时点观察组血清BNP、FIB较对照组均显著降低(均P<0.05)。术后3个月、6个月、12个月两组血清P1NP呈现出先升高后降低的趋势。术后3个月、6个月两组血清P1NP较术前均显著升高,且观察组均显著高于对照组(均P<0.05);术后12个月两组血清P1NP水平组间比较及与同组术前比较,差异均无统计学意义(均P>0.05)。结论:InterTan髓内钉联合股方肌蒂骨瓣移植治疗老年髋部骨折较空心螺钉内固定术操作难度大、手术�Objective To investigate the efficacy of InterTan intramedullary nail combined with quadratus femoris muscle pedicle bone flap grafting as a treatment of hip fractures and its influence on serum levels of B-type natriuretic peptide(BNP),fibrinogen(FIB)and procollagen type 1 amino-terminal propeptide(P1NP)in elderly patients.Methods A total of 78 elderly patients with hip fracture patients treated in our hospital between January 2016 and December 2018 were enrolled.All the patients had femoral neck fractures.According to random number table,they were divided into the control group and study group(n=39 each).The control group was treated with hollow screw internal fixation,while the study group was treated with InterTan intramedullary nail internal fixation combined with quadratus femoris muscle pedicle bone flap grafting.The treatment efficacy and serum levels of BNP,FIB and P1NP before and after treatment were compared between the two groups.Results The operation time,incision length,intraoperative blood loss,length of hospital stay and time to fracture healing were significantly shorter or lower in the control group than those in the study group(all P<0.05).The rates of excellent and good treatment efficacy in the study group and control group were 84.62%(33/39)and 61.54%(24/39),respectively,with significantly higher rates in the study group compared with the control group(χ2=5.278,P<0.05).Compared with before surgery,the visual analogue scale(VAS)scores were significantly lower,and the activity of daily living(ADL)scores were significantly increased,in either group at 1,6 and 12 months after surgery(all P<0.05).Over time,the VAS scores gradually decreased,and the ADL scores gradually increased in either group.At 1,6 and 12 months after surgery,the ADL scores were significantly higher in the study group than those in the control group(all P<0.05).There was no statistically significant difference in the VAS scores between the two groups before surgery and at any given time point after surgery(all P>0.05).The ove

关 键 词：髋部骨折 老年 InterTan髓内钉 骨瓣移植术 B型尿钠肽 纤维蛋白原 1型前胶原氨基末端前肽 

分 类 号：R687.3[医药卫生—骨科学]