摘要
目的探讨股骨转子间骨折(IFF)患者采用亚洲型股骨近端防旋髓内钉(PFNA-Ⅱ)治疗对凝血功能和髋关节功能的影响。方法选取2015年11月至2017年1月浙江省宁波市第二医院手术治疗的IFF患者90例,根据手术方法分为PFNA组(45例)和动力髋螺钉(DHS)组(45例)。对比2组患者的手术相关指标、凝血功能、血栓弹力图指标、髋关节功能。结果 PFNA组手术时间、出血量、切口大小、骨折愈合时间明显短于/少于/小于DHS组,差异均有统计学意义(均P <0. 01)。术前,2组凝血功能指标、血栓弹力图指标差异均无统计学意义(均P> 0. 05);术后3 d,PFNA组活化部分凝血酶时间、凝血酶时间、凝血酶原时间测定值明显高于DHS组[(48. 8±2. 8) s比(45. 0±3. 1) s、(19. 4±1. 2) s比(18. 3±1. 5) s、(17. 1±1. 8) s比(15. 5±1. 5) s],纤维蛋白原、D-二聚体测定值均明显低于DHS组[(4. 0±0. 7) g/L比(4. 5±0. 9) g/L、(0. 19±0. 07) mg/L比(0. 23±0. 09) mg/L]; PFNA组R值、K值测定值明显大于DHS组[(4. 9±0. 9) min比(4. 4±0. 8) min、(1. 60±0. 11) min比(1. 52±0. 13) min],α角测定值明显小于DHS组[(68±8)°比(75±9)°],差异均有统计学意义(均P <0. 01)。术后4个月,PFNA组患者的髋关节功能评价明显优于DHS组(Z=-2. 012,P=0. 044)。2组手术并发症发生率差异无统计学意义(P=0. 238)。结论 IFF患者采用PFNA-Ⅱ治疗手术效果可靠、术后康复快、对患者凝血功能影响小。
Objective To investigate the effect of Asian proximal femoral nail anti-rotation( PFNA-Ⅱ) on coagulation function and hip joint function in patients with intertrochanteric femur fracture( IFF). Methods From November 2015 to January 2017,90 IFF patients in Ningbo No. 2 Hospital were allocated to have PFNA surgery( PFNA group,n = 45) and dynamic hip screw( DHS) surgery( DHS group,n = 45). Surgical data,coagulation function,thrombelastogram and hip joint function were analyzed. Results Operation time,bleeding volume,incision size and fracture healing time in the PFNA group were significantly shorter/less than those in the DHS group( P < 0. 01). Before surgery,coagulation function and thrombelastogram indexes were similar between groups( P > 0. 05). Three days after surgery,values of activated partial thromboplastin time,thrombin time and prothrombin time in the PFNA group were significantly higher than those in the DHS group [( 48. 8 ± 2. 8) s vs( 45. 0 ± 3. 1) s,( 19. 4 ± 1. 2) s vs( 18. 3 ± 1. 5) s,( 17. 1 ± 1. 8) s vs( 15. 5 ± 1. 5) s]; levels of fibrinogen and D-dimer in the PFNA group were significantly lower than those in the DHS group[( 4. 0 ± 0. 7) g/L vs( 4. 5 ± 0. 9) g/L,( 0. 19 ± 0. 07) mg/L vs( 0. 23 ± 0. 09) mg/L]; R value and K value in the PFNA group were significantly higher than those in the DHS group[( 4. 9 ± 0. 9) min vs( 4. 4 ± 0. 8) min,( 1. 60 ± 0. 11) min vs( 1. 52 ± 0. 13) min];α angle in the PFNA group was significantly less than that in the DHS group[( 68 ± 8) ° vs( 75 ± 9) °]( all P <0. 01). Four months after surgery,hip function evaluation satisfactory effect,in the PFNA group was significantly better than that in the DHS group( Z =-2. 012,P = 0. 044). Incidence of complications showed no significant difference between groups( P = 0. 238). Conclusion PFNA-Ⅱ surgery shows rapid postoperative recovery and few effect on coagulation function in IFF patients.
引文
[1]钱朔,翟江华.高龄股骨粗隆间骨折患者PFNA内固定与半髋关节置换术的临床选择[J].现代仪器与医疗,2017,23(5):109-111.DOI:10.11876/mimt201705045.Qian S,Zhai JH.Clinical selection of PFNA internal fixation and partial hip replacement in elderly patients with intertrochanter fracture of femur[J].Modern Instruments&Mediccal Treatment,2017,23(5):109-111.DOI:10.11876/mimt201705045.
[2]王海洲,刘军,何倩伟,等.股骨近端防旋髓内钉与亚洲型股骨近端防旋髓内钉固定治疗股骨转子间骨折的疗效比较[J].中华创伤骨科杂志,2016,18(5):435-438.DOI:10.3760/cma.j.issn.1671-7600.2016.05.014.Wang HZ,Liu J,He QW,et al.Comparison of proximal femoral nail antirotation and proximal femoral nail antirotation-Ⅱin treatment of femur intertrochanteric fracture[J].Chinese Journal of Orthopaedic Trauma,2016,18(5):435-438.DOI:10.3760/cma.j.issn.1671-7600.2016.05.014.
[3]张帆,罗晓东,叶茂,等.PFNA与Gamma钉治疗股骨干骨折合并同侧股骨近端骨折的比较研究[J].疑难病杂志,2012,11(9):687-689.DOI:10.3969/j.issn.1671-6450.2012.09.014.Zhang F,Luo XD,Ye M,et al.Effects of PFNA and Gamma nail in treatment of femoral shaft fracture combined with ipsilateral fractures of the proximal femur[J].Chinese Journal of Difficult and Complicated Cases,2012,11(9):687-689.DOI:10.3969/j.issn.1671-6450.2012.09.014.
[4]李青松,袁晓伟,金敬尧,等.股骨近端防旋髓内钉与股骨近端锁定钢板治疗股骨粗隆间骨折疗效比较[J].中国骨与关节损伤杂志,2016,29(s1):25-26.Li QS,Yuan XW,Jin JY,et al.Effects of proximal femoral nail anti-rotation and locking proximal femoral plate on intertrochanteric fracture of femur[J].Chinese Journal of Bone and Joint Injury,2016,29(s1):25-26.
[5]杨小海,徐峰,尹自飞,等.亚洲型股骨近端防旋髓内钉内固定治疗老年股骨转子间骨折[J].中医正骨,2016,28(5):58-60.Yang XH,Xu F,Yin ZF,et al.Asia proximal femoral nail antirotation treating senile intertrochanteric femur fracture[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(5):58-60.
[6]贺洪辉,向亮,陆细红,等.股骨近端防旋髓内钉治疗外侧壁危险型股骨粗隆间骨折的疗效观察[J].中国骨与关节损伤杂志,2016,31(4):412-414.DOI:10.7531/j.issn.1672-9935.2016.04.027.He HH,Xiang L,Lu XH,et al.Efficacy of proximal femoral nail anti-rotation in treatment of intertrochanter fracture of femur[J].Chinese Journal of Bone and Joint Injury,2016,31(4):412-414.DOI:10.7531/j.issn.1672-9935.2016.04.027.
[7]何久盛,杜立,张国鑫,等.股骨近端防旋髓内钉与动力髋螺钉治疗成人股骨粗隆间骨折的meta分析[J].解放军医药杂志,2014,26(7):84-90.DOI:10.3969/j.issn.2095-140X.2014.07.022.He JS,Du L,Zhang GX,et al.A Meta-analysis of proximal femoral nail antirotation and dynamic hip screw in treatment of adults with intertrochanteric fractures[J].Medical&Pharmaceutical Journal of Chinese People's Liberation Army,2014,26(7):84-90.DOI:10.3969/j.issn.2095-140X.2014.07.022.
[8]Xie H,Wang Z,Zhang J,et al.Clinical outcome of dynamic hip locking plates and proximal femoral nails anti-rotation-Asia for treating intertrochanteric femur fracture with lateral wall fractures in the elder patients[J].Oncotarget,2017,8(47):82700-82704.DOI:10.18632/oncotarget.19754.
[9]Zeng X,Nan Z,Dan Z,et al.Proximal femoral nail antirotation versus dynamic hip screw fixation for treatment of osteoporotic type 31-A1intertrochanteric femoral fractures in elderly patients[J].J Int Med Res,2017,45(3):1109-1123.DOI:10.1177/0300060517703277.
[10]Hong JB,Dan Y,Ouyang L,et al.Biomechanical study on different lengths of PFNA fixation for unstable intertrochanteric femoral fractures[J].J Musculoskelet Neuronal Interact,2017,17(4):299-302.
[11]刘丁玮,张向敏,张朝阳,等.股骨近端防旋髓内钉和解剖锁定钢板治疗老年股骨转子间骨折的优劣分析[J].中国伤残医学,2016,24(14):21-22.DOI:10.13214/j.cnki.cjotadm.2016.14.014.Liu DW,Zhang XM,Zhang CY,et al.Advantages and disadvantages of proximal femoral nail anti-rotation and anatomical locking plate in the treatment of intertrochanteric femoral fracture in elderly patients[J].Chinese Journal of Trauma and Disability Medicine,2016,24(14):21-22.DOI:10.13214/j.cnki.cjotadm.2016.14.014.
[12]黄昆.微创股骨近端防旋髓内钉对老年股骨粗隆间骨折的治疗效果[J].临床医学,2016,36(2):78-79.Huang K.Therapeutic effect of minimal invasive proximal femoral nail anti-rotation on intertrochanteric femoral fracture in elderly patients[J].Clinical Medicine,2016,36(2):78-79.
