空心钉内固定联合股方肌骨瓣移植对青壮年股骨颈 骨折患者血液流变学及骨代谢指标的影响

Application of hollow nail internal fixation plus quadratus femoris bone flap transplantation in young patients with femoral neck fracture

摘要:

目的 探讨空心钉内固定联合股方肌骨瓣移植术对青壮年股骨颈骨折患者血液流变学及骨代谢指 标的影响。方法 选取2015 年10 月—2016 年12 月徐州市中心医院收治的96 例青壮年股骨颈骨折患者作为 研究对象，根据病历单双号随机分为观察组和对照组，每组48 例。对照组采用闭合复位空心钉内固定治疗； 观察组采用空心钉内固定联合股方肌骨瓣移植术治疗。比较两组手术相关指标、血液流变学、骨代谢指标、 临床疗效及并发症。结果 观察组手术时间高于对照组（P <0.05），术中出血量高于对照组（P <0.05），骨折愈合 时间低于对照组（P <0.05）；随访6 个月，观察组Harris 髋关节功能评分高于对照组（P <0.05）；术后3 个月，观 察组全血高切、全血低切、血浆黏度及红细胞比容均低于对照组（P <0.05），血清碱性磷酸酶（ALP）、骨保护 素（OPG）及骨钙素（BGP）含量高于对照组（P <0.05）；随访6 个月，观察组有效率（95.37%）高于对照组（79.17%） （P <0.05），股骨头坏死等并发症发生率（18.75%）低于对照组（37.50%）（P <0.05）。结论 空心钉内固定联合股 方肌骨瓣移植术有助于促进青壮年骨颈骨折患者术后康复，提高临床疗效，降低并发症发生率，可能与改善患 者血液流变学、调节骨代谢指标等因素有关。

Abstract:

Objective To investigate the application of hollow nail internal fixation combined with quadratus femoris bone flap transplantation in young patients with femoral neck fracture. Methods Totally 96 young patients with femoral neck fracture who were admitted into our hospital from October 2015 to December 2016 were enrolled and randomly divided into observation group in which patients received hollow nail internal fixation combined with quadratus femoris bone flap transplantation (n = 48), and control group in which patients received hollow nail internal fixation (n = 48). Operation related features, hemodynamics, bone metabolism, clinical efficacy and complications were recorded. Results Patients in observation group experienced increased levels of operative time and intraoperative blood loss, and decreased time duration of healing compared with control group (P < 0.05). At the 3rd month after surgery, the whole blood high shear, whole blood low shear, plasma viscosity and erythrocyte specific volume were decreased, while blood concentration of alkaline phosphatase (ALP), osteoprotegerin (OPG) and osteocalcin (BGP) were increased significantly in observation group when compared with those in control group (P < 0.05). At the 6th month after surgery, effective rate was enhanced while incidence of complications such as necrosis of femoral head was decreased in observation group compared with those in control group (95.37% vs 79.17%, 18.75% vs 37.50%, P < 0.05, respectively). Conclusions Hollow nail internal fixation combined with bone flap transplantation of quadratus femoris muscle can promote postoperative rehabilitation of young patients with bone and neck fracture, and reduce the incidence of adverse reactions.(P < 0.05). At the 6th month after surgery, effective rate was enhanced while incidence of complications such as necrosis of femoral head was decreased in observation group compared with those in control group (95.37% vs 79.17%, 18.75% vs 37.50%, P < 0.05, respectively). Conclusions Hollow nail internal fixation combined with bone flap transplantation of quadratus femoris muscle can promote postoperative rehabilitation of young patients with bone and neck fracture, and reduce the incidence of adverse reactions.