生物型股骨长柄半髋关节置换对老年股骨粗隆间骨折患者术后髋关节功能的影响  

The effect of biological long stem hemiarthroplasty on postoperative hip joint function in elderly patients with intertrochanteric fractures

作　　者：郭思远[1] 李环如 吴胜祥[1] Guo Siyuan;Li Huanru;Wu Shengxiang(Department of Orthopedics,General Hospital of Northern Anhui Coal and Power Group,Anhui Suzhou 234000,China)

机构地区：[1]皖北煤电集团总医院骨二科,安徽宿州234000

出　　处：《中国医师进修杂志》2021年第8期680-686,共7页Chinese Journal of Postgraduates of Medicine

基　　金：大连市科技创新基金计划项目(2019J13SN101)。

摘　　要：目的:探讨生物型股骨长柄半髋关节置换对老年股骨粗隆间骨折患者术后髋关节功能、血清骨性标志物、血管紧张素Ⅱ(AngⅡ)、皮质醇(Cor)水平的影响。方法:选取2017年6月至2019年6月在皖北煤电集团总医院行手术治疗的老年股骨粗隆间骨折患者120例,按非随机临床同期对照研究与患者自愿原则,分为关节置换组和内固定组,每组60例。内固定组行股骨近端防旋髓内钉(PFNA)内固定术,关节置换组行生物型股骨长柄半髋关节置换术。比较两组围手术期相关指标,并发症发生情况,手术前后血清AngⅡ、Cor水平,手术前后血清骨标志物骨钙素(OC)、降钙素(CT)、碱性磷酸酶(ALP)水平,手术前后Harris髋关节功能量表评分、Barthel指数(BI)评分、生命质量综合评定问卷(GQOL-74)评分及术后6个月髋关节功能优良率。结果:关节置换组下床活动时间短于内固定组,手术时间长于内固定组,术中出血量与术后引流量高于内固定组,差异均有统计学意义(P<0.05)。关节置换组术后并发症发生率低于内固定组[8.33%(5/60)比25.00%(15/60)],差异有统计学意义(χ2=6.000,P<0.05)。两组术后第1、3天血清AngⅡ、Cor水平较术前增高,并且关节置换组高于内固定组[术后第1天:(218.68±42.04)mmol/L比(158.19±34.36)mmol/L、(327.15±39.08)μg/L比(285.42±34.06)μg/L;术后第3天:(169.46±32.73)mmol/L比(138.02±25.97)mmol/L、(294.83±33.95)μg/L比(262.64±30.57)μg/L],差异均有统计学意义(P<0.05)。两组术后1、3个月血清OC、CT、ALP水平较术前增高,并且关节置换组高于内固定组[术后1个月:(17.40±4.25)μg/L比(14.96±3.79)μg/L、(1.34±0.49)ng/L比(1.15±0.43)ng/L、(159.49±19.75)U/L比(137.24±17.28)U/L;术后3个月:(19.18±5.79)μg/L比(16.24±4.36)μg/L、(1.46±0.57)ng/L比(1.24±0.50)ng/L、(180.94±22.42)U/L比(163.72±19.36)U/L],差异均有统计学意义(P<0.05)。两组术后1、3、6个月Harris髋关节功能量表评分较术�Objective To investigate the effect of biological long stem hemiarthroplasty on postoperative hip joint function,serum bone markers,angiotensinⅡ(AngⅡ)and cortisol(Cor)levels in elderly patients with intertrochanteric fractures.Methods A total of 120 elderly patients with intertrochanteric fractures in General Hospital of Northern Anhui Coal and Power Group from June 2017 to June 2019 were selected.According to the principle of non-randomized clinical concurrent controlled study and patient′s voluntariness,they were divided into arthroplasty group and internal fixation group,with 60 cases in each group.Proximal femoral nail antirotation(PFNA)was used in the internal fixation group,and the biological long stem hemiarthroplasty was performed in the arthroplasty group.The related indexes of perioperative operation and complications,the levels of serum AngⅡand Cor before and after operation,the levels of serum bone markers osteocalcin(OC),calcitonin(CT),alkaline phosphatase(ALP)before and after operation were compared between the two groups.After followed up for 6 months after the operation,Harris hip function score and Barthel index(BI)score,quality of life score(GQOL-74)before and after operation,and the excellent and good rate of hip joint function at 6 months after operation were compared between the two groups.Results The time of getting out of bed in the arthroplasty group was shorter than that in the internal fixation group,the operation time was longer than that in the internal fixation group,and the amount of blood loss and postoperative drainage were higher than those in the internal fixation group,and the differences were statistically significant(P<0.05).The postoperative complication rate in the arthroplasty group was lower than that in the internal fixation group:8.33%(5/60)vs.25.00%(15/60),and the difference was statistically significant(χ2=6.000,P<0.05).The levels of serum AngⅡand Cor in the two groups were higher than those before the operation at the 1st and 3rd day after the operation,but

关 键 词：关节成形术 置换 髋 髋骨折 髋关节功能 老年人 

分 类 号：R687.3[医药卫生—骨科学]