【摘要】 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。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3 d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。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。更多还原

【Abstract】 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 intramedullary nail and dynamic hip screw on blood volume of blood circulation system in elderly patients with intertrochanteric fractures.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 enrolled in this study. These patients were assigned to two groups(n=24). Patients in the observation group received treatment with proximal femoral intramedullary 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.更多还原