中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2015年
35期
5652-5657
,共6页
植入物%骨植入物%循环系统血容量%股骨转子间骨折%股骨近端髓内钉%动力髋螺钉%并发症%髋关节功能%Harris评分
植入物%骨植入物%循環繫統血容量%股骨轉子間骨摺%股骨近耑髓內釘%動力髖螺釘%併髮癥%髖關節功能%Harris評分
식입물%골식입물%순배계통혈용량%고골전자간골절%고골근단수내정%동력관라정%병발증%관관절공능%Harris평분
Femoral Fractures%Bone Nails%Blood Loss,Surgical
背景：股骨转子间骨折老年患者治疗的关键在于选取适当的内固定方案，但是关于不同内固定方案对股骨转子间骨折老年患者血循环系统血容量影响的研究不多。<br> 目的：观察股骨近端髓内钉与动力髋螺钉对股骨转子间骨折老年患者循环系统血容量的影响，并进行对比。方法：选取2012年1月至2014年9月南京中医药大学江阴附属医院收治的股骨转子间骨折老年患者48例，采用随机数表法分为两组，每组24例。观察组患者行股骨近端髓内钉置入内固定治疗，对照组患者行动力髋螺钉置入内固定治疗。比较两组患者的术后失血量、围手术期输血量、治疗前与治疗后3d的血红蛋白差值、治疗后并发症发生率、显性失血及隐性失血情况，并对两组患者治疗后4，12个月的髋关节活动度和髋关节功能Harris评分进行比较。<br> 结果与结论：观察组患者的术中失血量少于对照组患者(P<0.05)。两组患者的围手术期输血量、治疗前与治疗后3 d 的血红蛋白差值比较，差异无显著性意义(P >0.05)。观察组患者的手术时间显著长于对照组(P <0.05)。观察组患者的治疗后并发症发生率显著低于对照组(P<0.05)。两组患者的住院时间差异无显著性意义(P>0.05)。同时间段内观察组患者的髋关节活动度和髋关节功能Harris评分均优于对照组患者，差异有显著性意义(P<0.05)。观察组患者的失血总量、显性失血量均少于对照组，隐性失血量多于对照组，差异有显著性意义(P<0.05)。提示与动力髋螺钉相比，股骨近端髓内钉置入内固定修复股骨转子间骨折术中失血量较少，治疗后并发症发生率较低，治疗后髋关节活动度和髋关节功能评分较佳；但是股骨近端髓内钉置入的手术时间较长，两种内固定方案的血红蛋白差值和围手术期输血量无明显差异。
揹景：股骨轉子間骨摺老年患者治療的關鍵在于選取適噹的內固定方案，但是關于不同內固定方案對股骨轉子間骨摺老年患者血循環繫統血容量影響的研究不多。<br> 目的：觀察股骨近耑髓內釘與動力髖螺釘對股骨轉子間骨摺老年患者循環繫統血容量的影響，併進行對比。方法：選取2012年1月至2014年9月南京中醫藥大學江陰附屬醫院收治的股骨轉子間骨摺老年患者48例，採用隨機數錶法分為兩組，每組24例。觀察組患者行股骨近耑髓內釘置入內固定治療，對照組患者行動力髖螺釘置入內固定治療。比較兩組患者的術後失血量、圍手術期輸血量、治療前與治療後3d的血紅蛋白差值、治療後併髮癥髮生率、顯性失血及隱性失血情況，併對兩組患者治療後4，12箇月的髖關節活動度和髖關節功能Harris評分進行比較。<br> 結果與結論：觀察組患者的術中失血量少于對照組患者(P<0.05)。兩組患者的圍手術期輸血量、治療前與治療後3 d 的血紅蛋白差值比較，差異無顯著性意義(P >0.05)。觀察組患者的手術時間顯著長于對照組(P <0.05)。觀察組患者的治療後併髮癥髮生率顯著低于對照組(P<0.05)。兩組患者的住院時間差異無顯著性意義(P>0.05)。同時間段內觀察組患者的髖關節活動度和髖關節功能Harris評分均優于對照組患者，差異有顯著性意義(P<0.05)。觀察組患者的失血總量、顯性失血量均少于對照組，隱性失血量多于對照組，差異有顯著性意義(P<0.05)。提示與動力髖螺釘相比，股骨近耑髓內釘置入內固定脩複股骨轉子間骨摺術中失血量較少，治療後併髮癥髮生率較低，治療後髖關節活動度和髖關節功能評分較佳；但是股骨近耑髓內釘置入的手術時間較長，兩種內固定方案的血紅蛋白差值和圍手術期輸血量無明顯差異。
배경：고골전자간골절노년환자치료적관건재우선취괄당적내고정방안，단시관우불동내고정방안대고골전자간골절노년환자혈순배계통혈용량영향적연구불다。<br> 목적：관찰고골근단수내정여동력관라정대고골전자간골절노년환자순배계통혈용량적영향，병진행대비。방법：선취2012년1월지2014년9월남경중의약대학강음부속의원수치적고골전자간골절노년환자48례，채용수궤수표법분위량조，매조24례。관찰조환자행고골근단수내정치입내고정치료，대조조환자행동력관라정치입내고정치료。비교량조환자적술후실혈량、위수술기수혈량、치료전여치료후3d적혈홍단백차치、치료후병발증발생솔、현성실혈급은성실혈정황，병대량조환자치료후4，12개월적관관절활동도화관관절공능Harris평분진행비교。<br> 결과여결론：관찰조환자적술중실혈량소우대조조환자(P<0.05)。량조환자적위수술기수혈량、치료전여치료후3 d 적혈홍단백차치비교，차이무현저성의의(P >0.05)。관찰조환자적수술시간현저장우대조조(P <0.05)。관찰조환자적치료후병발증발생솔현저저우대조조(P<0.05)。량조환자적주원시간차이무현저성의의(P>0.05)。동시간단내관찰조환자적관관절활동도화관관절공능Harris평분균우우대조조환자，차이유현저성의의(P<0.05)。관찰조환자적실혈총량、현성실혈량균소우대조조，은성실혈량다우대조조，차이유현저성의의(P<0.05)。제시여동력관라정상비，고골근단수내정치입내고정수복고골전자간골절술중실혈량교소，치료후병발증발생솔교저，치료후관관절활동도화관관절공능평분교가；단시고골근단수내정치입적수술시간교장，량충내고정방안적혈홍단백차치화위수술기수혈량무명현차이。
BACKGROUND:The key of intertrochanteric fractures in elderly patients is to select the appropriate fixation, but few clinical studies concerned different fixation methods for blood volume of blood circulation system in elderly patients with intertrochanteric fractures. OBJECTIVE:To compare the effects of proximal femoral intramedul ary nail and dynamic hip screw on blood volume of blood circulation system in elderly patients with intertrochanteric fractures. <br> METHODS:A total of 48 elderly patients with intertrochanteric fractures, who were treated in the Jiangyin Hospital Affiliated to Nanjing University of Traditional Chinese Medicine from January 2012 to September 2014, were enrol ed in this study. These patients were assigned to two groups (n=24). Patients in the observation group received treatment with proximal femoral intramedul ary nail, and patients in the control group received treatment with dynamic hip screw. Postoperative blood loss, perioperative blood transfusion, preoperative and 3-day postoperative hemoglobin difference, incidence of postoperative complications, dominant blood loss, and hidden blood loss were compared between the two groups. Range of motion of the hip and Harris score of the hip were compared between the two groups at 4 and 12 months post surgery. RESULTS AND CONCLUSION:Intraoperative blood loss was less in the observation group than in the control group (P<0.05). No significant differences in perioperative blood transfusion and preoperative and 3-day postoperative hemoglobin were detected between the two groups (P>0.05). The operation time was significantly longer in the observation group than in the control group (P<0.05). The incidence of postoperative complications was significantly lower in the observation group than in the control group (P<0.05). No significant difference in length of hospital stay was detected between the two groups (P>0.05). Within the same time period, the range of motion of the hip and Harris score of the hip were better in the observation group than in the control group (P<0.05). The total amount of blood loss and dominant blood loss were less in the observation group than in the control group (P<0.05). These findings indicate that compared with the dynamic hip screw, proximal femoral nail fixation for intertrochanteric fracture has less intraoperative blood loss, lower incidence of postoperative complications, postoperative range of motion of the hip and better hip score. However, operation time of proximal femoral nail was long. There were no significant differences in hemoglobin difference and perioperative blood transfusion between the two fixation methods.
