摘要
目的 探讨闭合复位髓内钉内固定术(interlocking intramedullary nail,IMN)和人工股骨头置换术(artificial femoral head replacement,AFHR)在股骨粗隆间骨折患者中的疗效及安全性。方法 回顾性分析2022年1月至2024年12月在普定县人民医院就诊的158例股骨粗隆间骨折患者的临床资料,根据术式分为IMN组(79例)和AFHR组(79例)。比较两组研究对象临床疗效、术中相关指标、术后恢复效率相关指标、髋关节功能(Harris评分)、疼痛程度(VAS评分)、并发症的发生情况。结果 相较于AFHR组,IMN组患者的临床总有效率明显更高(97.47%vs. 79.75%,P<0.05);不良反应总发生率明显更低(6.33%vs. 18.99%,P<0.05)。相较于AFHR组,IMN组患者术中出血量更少,手术切口长度、手术时间、住院时间,下地负重时间和骨折愈合时间更短,而透视次数更多(P<0.001)。术前,两组患者髋关节功能评分(Harris评分)、疼痛视觉模拟评分(VAS评分)无明显差异(P>0.05)。术后,随着时间的延长,两组患者的Harris评分呈逐渐升高趋势,VAS评分呈逐渐降低趋势;相较于AFHR组,IMN组患者术后7d、术后1个月、术后1年的Harris评分更高(P<0.05);术后7d、术后1个月的VAS评分更低(P<0.001)。结论 IMN在股骨粗隆间骨折治疗中具有创伤小、恢复快、并发症少、临床疗效显著等优势,可作为多数患者的首选术式。
Objective To compare the efficacy and safety of closed reduction with interlocking intramedullary nailing(IMN)and artificial femoral head replacement(AFHR)in the treatment of intertrochanteric femur fractures.Methods A retrospective analysis was conducted on the clinical data of 158 patients with intertrochanteric femur fractures who were treated at Puding County People's Hospital from January 2022 to December 2024.Patients were divided into two groups based on the surgical method:the IMN group(79 cases)and the AFHR group(79 cases).The clinical outcomes,intraoperative parameters,postoperative recovery indicators,hip joint function(Harris score),pain levels(VAS score),and complications were compared between the two groups.Results Compared to the AFHR group,the IMN group had a significantly higher total clinical eff ective rate(97.47%vs.79.75%,P<0.05)and a significantly lower overall incidence of adverse reactions(6.33%vs.18.99%,P<0.05).The IMN group also had less intraoperative blood loss,shorter surgical incision length,shorter operation time,shorter hospitalization time,earlier weight-bearing time,and faster fracture healing time.However,the IMN group required more fluoroscopic imaging during the procedure(P<0.001).Preoperatively,there were no significant diff erences between the two groups in terms of hip joint function(Harris score)and pain level(VAS score)(P>0.05).Postoperatively,both groups showed a gradual increase in the Harris score and a gradual decrease in the VAS score over time.The IMN group had higher Harris scores at 7 days,1 month,and 1 year postoperatively,as well as lower VAS scores at 7 days and 1 month postoperatively,compared to the AFHR group(P<0.05).Conclusion IMN off ers advantages such as minimal trauma,faster recovery,fewer complications,and significant clinical efficacy in the treatment of intertrochanteric femur fractures.It can be considered the preferred surgical option for most patients.
作者
夏德仓
江雪
张军
郭庆
XIA Dechang;JIANG Xue;ZHANG Jun;GUO Qing(Department of Orthopedics,Puding County People's Hospital,Puding,Guizhou 562100,China;Nursing Department,Puding County People's Hospital,Puding,Guizhou 562100,China)
出处
《中华灾害救援医学》
2025年第5期519-523,共5页
Chinese Journal of Disaster Medicine
基金
2025年度贵州省卫生健康委科学技术基金立项项目(gzwkj2025-609)。
关键词
闭合复位髓内钉内固定术
人工股骨头置换术
股骨粗隆间骨折
Closed reduction with intramedullary nailing
Artificial femoral head replacement
Intertrochanteric femur fracture
