论文部分内容阅读
目的 探讨可膨胀股骨近端髓内钉 (EPFN) 与股骨近端防旋刀片髓内钉 (PFNAⅡ)内固定治疗股骨转子间骨折的疗效及对患者血流变学、骨代谢、血液相关指标和髋关节功能的影响.方法选取我院收治的股骨转子间骨折患者90例,将其随机分为对照组 (n =45) 和治疗组 (n =45).治疗组行PFNAⅡ内固定微创治疗,对照组行EPFN内固定治疗.分析并比较两组手术指标、手术前后血流变学指标、骨代谢及血液相关指标.采用Harris评分系统评价两组患者髋关节功能的变化.结果 与对照组比较,治疗组术中出血量明显减少,手术时间、愈合时间和负重时间明显缩短 (P <0.05或 P <0.01).术后两组全血粘度、血浆粘度、红细胞比容和红细胞刚性指数等血流变学指标均较术前显著下降,而红细胞变形指数较术前明显升高 (P<0.05或P<0.01),且组间差异显著 (P <0.05或P <0.01).术后治疗组Ⅰ型前胶原氨基末端前肽 (PINP)、甲状旁腺素 (PTH)、25 -羟基维生素 D3 (25 - (OH)2D3) 水平和Harris评分均显著高于术前 (P<0.05或P<0.01),并且治疗组显著高于对照组 (P 0.05),但Harris评分显著高于术前 (P<0.01).术后两组C-反应蛋白 (CRP)、超肌红蛋白 (Myo) 和肌酸磷酸酶 (CK) 水平较术前显著降低 (P<0.05或 P <0.01),且治疗组显著低于对照组 (P<0.05或P<0.01).结论 PFNAⅡ内固定微创治疗股骨转子间骨折的手术时间短,术中出血量少,可改善机体血液高凝状态,平衡机体血骨代谢指标水平,更有利于机体髋关节功能恢复,疗效确切.“,”Objective To explore the effect and influence of expandable procimal femoral nail (EPFN) combined with proximal femoral nail anti-rotation II(PFNA II) on the hemorrheology, bone metabolism and hip joint function in the treatment of in-tertrochanteric fracture. Methods 90 Intertrochanteric fracture patients in our hospital were elected and divided randomly into the control group (n=45) and the treatment group (n=45). Treatment group received the internal fixation of minimally invasive treat-ment of PFNAⅡ and the control group received internal fixation treatment of EPFN. The operation indicators, preoperative and post-operative hemorrheology indexes, bone metabolism indexes and blood related indicators in the two groups were analyzed and compared. The changes of hip joint function in the two groups were evaluated by Harris points-scoring system. Results Compared with the con-trol group, the intraoperative blood loss decreased significantly; and the operation time, healing time and load time shortened signifi-cantly in the treatment group (P<0.05 or P<0.01). The hemorrheology indexes of whole blood viscosity, plasma viscosity, red blood cell specific volume and the erythrocyte rigidity indexes in the groups decreased significantly after the operation. The erythrocyte deformation indexes increased significantly after the operation than before the operation (P<0.05 or P<0.01). There was significant difference between the two groups (P<0.05 or P<0.01). Compared with the preoperation, the levels of preoperative PINP, para-thyroid hormone and 25- (OH)2D3and the Harris scores increased significantly (P<0.05 or P<0.01), and the ones in the treat-ment group were higher than those in the control group (P0.05). Harris scores were higher after the operation than before the operation (P<0.01). Compared with the preoperation, the levels of commercial rent planning, myoglobin and creatine phosphatase decreased significantly (P<0.05 or P<0.01), and the ones in treatment group were lower than those in the control group (P<0.05 or P<0.01). Conclusion The operation time of the internal fixation of minimally invasive treatment of PFNAⅡin the treatment of intertrochanteric fracture is short and has less intraoperative blood loss, which can improve high condensa-tion state, balance the blood bone metabolism indexes and promote the recovery of hip joint function.