梁耘,张斌,李昌坤,杨先武,戴伟,周珊
LIANG Yun,ZHANG Bin,LI Changkun,YANG Xianwu,DAI Wei,ZHOU Shan

• 1:江油市人民医院下肢关节科

摘要(Abstract)：

目的 分析不同手术时点人工股骨头置换术联合加速康复锻炼治疗对高龄老年股骨粗隆间骨折的疗效。方法 选择高龄股骨粗隆间骨折患者104例，均接受人工股骨头置换术联合加速康复锻炼治疗，根据手术时点进行分组，创伤至手术时间≤24 h为A组(n=55)、> 24 h为B组(n=49)，比较两组患者围术期指标;分别于术前及术后采用Harris髋关节评分量表评估髋关节功能情况，疼痛视觉模拟评分(VAS)评估疼痛程度，Barthel指数评估日常生活能力，比较两组患者术前及术后的白细胞介素-6(IL-6)、白细胞介素-10(IL-10)和肿瘤坏死因子-α(TNF-α)水平，统计两组患者术后并发症情况。结果 两组患者手术时间、显性失血量、术后首次负重时间及住院时间比较，差异无统计学意义(P> 0.05); A组隐性失血量显著高于B组(P <0.05);术后6个月时，A组髋关节功能评分高于B组(P <0.05);术后6个月时，A组日常生活能力评分高于B组(P <0.05);术后7 d时，A组IL-6、IL-10及TNF-α水平比较低于B组(P <0.05);两组患者均未出现远期并发症，近期并发症发生率比较，差异无统计学意义(P> 0.05)。结论 创伤至手术时间≤24 h接受人工股骨头置换术联合加速康复锻炼治疗可促进高龄老年股骨粗隆间骨折患者髋关节功能及日常生活能力的恢复。
Objective To investigate the therapeutic effects of artificial femoral head replacement a different time points combined with accelerated rehabilitation exercise on elder patients with femora intertrochanteric fracture.Methods A total of 104 elder patients with femoral intertrochanteric fracture treated with artificial femoral head replacement combined with accelerated rehabilitation exercise were divided into group A (fracture to operation≤24 h,n=55) and group B fracture to operation>24 h,n=49) according to the time points of operation.Perioperative indicators were compared between both groups.Harris Hip Score,the Visual Analog Scale (VAS),and Barthel index were used to evaluate hip function,pain degree and activities of daily living ability before and after surgery respectively.Levels of IL-6,IL-10,and TNF-α in both groups were compared before and after operation.Incidence rates of postoperative complications were calculated.Results There was no statistically significant differences in operation time,obvious blood loss,postoperative first weightbearing time or hospital stay between both groups (P>0.05).The hidden blood loss of group A was significantly more than that of group B (P<0.05).6 months after operation,the hip function score and activities of daily living score of group A were higher than those of group B (P<0.05).On day 7after operation,the levels of IL-6,IL-10,and TNF-α of group A were lower than those of group B(P<0.05).No long-term complications were observed in either group,and there was no statistically significant difference in the incidence rate of short-term complications between the groups (P>0.05).Conclusion Conducting artificial femoral head replacement within 24 h after fracture combined with accelerated rehabilitation exercise could promote the recovery of hip function and activities of daily living for elder patients with femoral intertrochanteric fracture.

关键词(KeyWords)： 人工股骨头置换术;加速康复理念;高龄;二股骨粗隆间骨折;手术时点
artificial femoral head replacement;accelerated rehabilitation concept;elder;femoral intertrochanteric fracture;time points of operation

Abstract:

Keywords:

基金项目(Foundation): 2020年四川省医学会骨科(尚安通)专项科研课题(2020SAT28)

作者(Author): 梁耘,张斌,李昌坤,杨先武,戴伟,周珊
LIANG Yun,ZHANG Bin,LI Changkun,YANG Xianwu,DAI Wei,ZHOU Shan

DOI: 10.19367/j.cnki.2096-8388.2023.02.019

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