【摘要】 目的 研究Gotfried支撑复位(GSR)治疗股骨颈骨折(TF)中青年患者的临床疗效。方法 前瞻性纳入2017年1月至2019年12月在河北省沧州中西医结合医院脊柱脊髓外科治疗的中青年TF患者68例，依据随机数字表法将其分为GSR组(n=34)与对照组(n=34)。GSR组行GSR+内固定治疗，对照组行内固定治疗。观察两组患者手术时间、住院时间、骨折愈合时间、负重时间等手术及骨折恢复指标，术后1年髋关节评分、颈短缩分度;术前、术后1个月前列腺素E2(PGE2)、5-羟色胺(5-HT)、缓激肽(BK)、脑内神经肽Y(NPY)等致痛因子，术后1年内并发症等指标。结果 GSR组手术时间为(88.96±9.27) min，大于对照组手术时间[(79.95±8.18) min],GSR组住院时间、骨折愈合时间、部分负重时间、完全负重时间为(7.69±0.83)、(115.64±12.83)、(119.79±12.77)、(157.92±16.89) d，均小于对照组住院时间[(10.94±1.16)、(141.55±15.75)、(152.73±16.93)、(189.95±20.38) d]，差异均有统计学意义(P <0.05)。术后1年，GSR组髋关节功能、活动范围、疼痛、畸形及髋关节总评分为(29.97±3.38)、(3.81±0.41)、(44.31±4.63)、(4.86±0.52)、(82.95±8.94)分，均大于对照组[(23.86±2.47)、(3.34±0.35)、(38.53±3.96)、(4.22±0.45)、(69.95±7.23)分]，差异均有统计学意义(P <0.05)。GSR组术后1年颈短缩分度情况优于对照组，差异有统计学意义(P <0.05)。术后1个月，GSR组PGE2、5-HT、BK、NPY水平为(121.85±13.69) pg/m L、(133.14±14.67) ng/L、(5.39±0.47)μg/L、(138.86±16.14)μg/L，低于对照组[(258.93±26.92) pg/m L、(178.69±19.38) ng/L、(8.22±0.84)μg/L、(193.78±21.33)μg/L]，差异均有统计学意义(P <0.05)。术后1年内，GSR组术后并发症发生率为5.88%，低于对照组(26.47%)，差异有统计学意义(P <0.05)。结论 GSR治疗中青年TF可实现骨折外翻复位及阳性支撑重建，改善髋关节功能，避免颈短缩，减少术后并发症，缓解疼痛，有助于患者康复。更多还原

【Abstract】 Objective To study the clinical efficacy of got fried support reset( GSR) in the treatment of transcervical fracture( TF) in young and middle-aged patients. Methods A total of 68 young and middle-aged TF patients treated by Department of Spinal and Spinal cord Surgery,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Hebei Province from January 2017 to December 2019 were divided into GSR group( n = 34) and control group( n = 34) according to random number table method. GSR group was treated with GSR internal fixation while control group was treated with internal fixation. The operation time,hospitalization time,fracture healing time,weight-bearing time and other operation and fracture recovery indexes,the hip joint score and neck shortening index 1 year after operation,pain factors such as prostaglandin E2( PGE2),5-hydroxytryptamine( 5-HT),bradykinin( BK) and neuropeptide Y( NPY) in the brain before and 1 month after operation,complications within 1 year after surgery,etc of the two groups were observed. Results The operative time of GSR group was( 88. 96 ± 9. 27) min,which was longer than that of the control group[( 79. 95 ± 8. 18) min],the length of hospital stay,fracture healing time,partial weight-bearing time,full weight-bearing time of GSR group were( 7. 69 ± 0. 83) d,( 115. 64 ± 12. 83) d,( 119. 79 ± 12. 77) d,( 157. 92 ± 16. 89) d,which were shorter than those of control group[( 10. 94 ± 1. 16) d,( 141. 55 ± 15. 75) d,( 152. 73 ± 16. 93) d,( 189. 95± 20. 38) d],and the differences were statistically significant( P < 0. 05). One year after operation,the hip function,range of motion,pain,deformity and total hip score in GSR group were( 29. 97 ± 3. 38) pionts,( 3. 81 ± 0. 41) pionts,( 44. 31 ± 4. 63) pionts,( 4. 86 ± 0. 52) pionts,( 82. 95 ± 8. 94) pionts,which were higher than those in the control group[( 23. 86 ± 2. 47) pionts,( 3. 34 ± 0. 35) pionts,( 38. 53 ± 3. 96) pionts,( 4. 22 ± 0. 45) pionts and( 69. 95 ± 7. 23) pionts],the differences were statistically significant( P < 0. 05). The degree of cervical shortening in GSR group was better than that in control group one year after operation,the difference was statistically significant( P < 0. 05). One month after operation,PGE2,5-HT,BK and NPY in GSR group were( 121. 85 ± 13. 69) pg/m L,( 133. 14 ± 14. 67) ng/L,( 5. 39 ± 0. 47)μg/L,( 138. 86 ± 16. 14) μg/L,which were lower than those in control group[( 258. 93 ± 26. 92) pg/m L,( 178. 69 ± 19. 38) ng/L,( 8. 22 ±0. 84) μg/L,( 193. 78 ± 21. 33) μg/L],the differences were statistically significant( P < 0. 05). Within one year after surgery,the incidence of postoperative complications in GSR group was 5. 88%,which was lower than that in control group( 26. 47%),the difference was statistically significant( P < 0. 05). Conclusion GSR can achieve fracture eversion reduction and positive support reconstruction,improve hip joint function,avoid neck shortening,reduce postoperative complications,relieve pain and help patients recover.更多还原