摘要
目的 比较股骨头置换与髓内钉置入治疗股骨转子间骨折(IFF)的临床疗效,以及对血清血栓素A2(TXA2)、肿瘤坏死因子-α(TNF-α)和神经元特异性烯醇化酶(NSE)的影响。方法 采用回顾性方法,选择2022年5月至2024年5月在新疆维吾尔自治区人民医院诊断为IFF患者178例,其中男性102例,女性76例;年龄64~76岁,平均年龄69.5岁;身体质量指数22.5~26.9 kg/m^(2),平均身体质量指数25.4 kg/m^(2);骨折部位左93例,右85例;Evans分型Ⅲ68例,Ⅳ64例,Ⅴ46例;骨质疏松104例;住院时间7~15 d,平均住院时间10.5 d。根据治疗方式不同分为双极长柄人工股骨头置换(观察组)84例和股骨近端防旋髓内钉(PFNA)置入(对照组)94例。比较两组治疗前后髋关节Harris评分,评估优良率;术后和随访6个月并发症发生率,凝血功能[包括活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)和D-二聚体]、TXA2、TNF-α和NSE水平。结果 两组随访6个月Harris评分均显著提高,且观察组明显高于对照组[(89.9±3.5)分vs(85.6±3.3)分],优良率增加[95.2%(80/84) vs 86.2%(81/94)](P<0.05)。两组并发症发生率比较,差异无统计学意义(P > 0.05)。两组术后1个月APTT、FIB、D-二聚体、TXA2、TNF-α和NSE水平较治疗前增加,但观察组仍低于对照组[(35.5±6.3) s vs(40.2±6.9) s、(5.6±1.5) g/L vs(6.2±1.6) g/L、(3.5±0.4) mg/L vs(4.3±0.5) mg/L、(165.5±32.3) ng/L vs(198.9±35.6) ng/L、(16.9±3.5) mg/L vs(19.8±3.7) mg/L、(11.3±2.6) ng/mL vs(14.5±2.3) ng/mL](P<0.05)。结论 股骨头置换和PFNA均是临床治疗IFF的常用术式,股骨头置换的总体疗效似乎更佳,尤其对凝血功能、TXA2、TNF-α和NSE水平的干扰较小。
Objective To compare the clinical efficacy of femoral head replacement and intramedullary nail placement in treatment of intertrochanteric fracture(IFF),and probe their effects on serum levels of thromboxane A2(TXA2),tumor necrosis factor-α(TNF-α)and neuron-specific enolase(NSE).Methods From May 2022 to May 2024,a total of 178 patients diagnosed with IFF were enrolled by retrospective method,which included 102 males and 76 females,aged 64-76 years old with mean age of 69.5 years old;body mass index(BMI)was 22.5-26.9 kg/m^(2)with mean BMI of 25.4 kg/m^(2);93 cases of left fracture and 85 of right fracture;68 cases of Evans classification II,64 of Evans classification IV and 46 of Evans classification V;104 cases of osteoporosis;hospitalization time was 7-15 days with mean time of 10.5 days.According to treatment methods,all of them were divided into bipolar long-stem artificial femoral head replacement(observation group,n=84)and proximal femoral nail antirotation(PFNA)implantation(control group,n=94).The Harris scores of hip joint before and after treatment between 2 groups were compared,and the superior rate was evaluated.The incidence of complications,coagulation function[activated partial thromboplastin time(APTT),fibrinogen(FIB)and D-dimer],as well as serum levels of TXA2,TNF-αand NSE levels were measured after operation and 6-month of follow-up.Results The Harris scores of 2 groups were significantly improved at 6-month of follow-up,and observation group was significantly higher than control group[(89.9±3.5)scores vs(85.6±3.3)scores],and superior rate of observation group was significantly increased than that of observation group[95.2%(80/84)vs 86.2%(81/94)](P<0.05).There was no significant difference in the incidence of complications between 2 groups(P>0.05).The serum levels of APTT,FIB,D-dimer,TXA2,TNF-αand NSE in 2 groups at 1-month after operation were higher than those before treatment,and the above parameters in observation group were significantly lower than those in control group[(35.5±6.3)seconds vs(40.2±6.9)seconds,(5.6±1.5)g/L us(6.2±1.6)g/L,(3.5±0.4)mg/L vs(4.3±0.5)mg/L,(165.5±32.3)ng/L vs(198.9±35.6)ng/L,(16.9±3.5)mg/L vs(19.8±3.7)mg/L,(11.3±2.6)ng/mL vs(14.5±2.3)ng/mL)(P<0.05)].Conclusion It is demonstrated that femoral head replacement and PFNA are commonly surgical approaches for clinical treatment of IFF.The overall efficacy of femoral head replacement is relatively better,with less interference on coagulation function,TXA2,TNF-α,and NSE levels.
作者
刘天泽
许建
LIU Tianze;XU Jian(Department Il of Emergency Center;Joint Movement Ward of Orthopedic Center,People's Hospital of Xinjiang UygurAutonomous Region,Urumqi 830001,Xinjiang,China)
出处
《生物医学工程与临床》
2025年第4期505-510,共6页
Biomedical Engineering and Clinical Medicine
基金
新疆维吾尔自治区人民医院精准医学项目(20220305)。
