非骨水泥股骨假体置换联合术中股骨大转子重建对不稳定股骨转子间骨折的疗效分析

Therapeutic effects of non-cemented femoral prosthetic replacement combined with intraoperative reconstruction of the greater trochanter for unstable intertrochanteric fractures

摘要:

目的 探讨非骨水泥股骨假体置换联合术中股骨大转子重建对不稳定股骨转子间骨折的疗效。方法 选取2016年7月—2021年6月广西中医药大学附属瑞康医院收治的86例不稳定股骨转子间骨折患者，并随机分为对照组、研究组，每组43例。对照组给予非骨水泥股骨假体置换治疗，研究组给予非骨水泥股骨假体置换联合术中股骨大转子重建治疗，术后随访6个月。对比两组手术及骨折愈合情况，评价两组术后6个月髋关节功能，对比两组术后6个月的股骨颈干角、股骨前倾角，比较两组外周血骨代谢指标，评估两组手术前后下肢功能及日常生活能力，统计两组术后并发症发生情况。结果 两组手术时间、术中出血量比较，差异无统计学意义（P >0.05）；研究组骨折愈合时间短于对照组（P <0.05）。研究组髋关节Harris评分优良率高于对照组（P <0.05）。研究组手术前后ALP、BMP-2、LEFS评分、Barthel指数评分的差值高于对照组（P <0.05）。两组患者术后6个月的股骨颈干角、股骨前倾角、总并发症发生率比较，差异无统计学意义（P >0.05）。结论 非骨水泥股骨假体置换联合术中股骨大转子重建用于不稳定股骨转子间骨折可获取良好疗效，术中给予股骨大转子重建在促进骨折愈合、改善髋关节功能方面更具优势。

Abstract:

Objective To investigate the therapeutic effect of non-cemented femoral prosthetic replacement combined with intraoperative reconstruction of greater trochanter for unstable intertrochanteric fractures.Methods A total of 86 patients with unstable femoral intertrochanteric fractures who were treated in our hospital from July 2016 to June 2021 were selected, and were randomly divided into control group and study group, with 43 cases in each group. The control group was given non-cemented femoral prosthetic replacement, and the study group was given non-cemented femoral prosthetic replacement combined with intraoperative reconstruction of the greater trochanter. The patients were followed up for 6 months. The operation and fracture healing of the two groups were compared. The hip joint function of the two groups at 6 months after the operation was compared, and the femoral neck shaft angle and femoral anteversion angle at 6 months after the operation were also compared between the two groups. The indicators for bone metabolism in the peripheral blood of the two groups were observed. The lower limb function and ability of daily living before and after the operation were compared, and the incidence of postoperative complications in the two groups was analyzed.Results There was no significant difference in the operative duration and intraoperative blood loss between the two groups (P > 0.05). The fracture healing time of the study group was shorter than that of the control group (P < 0.05). The excellent and good rates of Harris Hip Scale scores in the study group were higher than those in the control group (P < 0.05). The differences of the levels of alkaline phosphatase (ALP) and bone morphogenetic protein-2 (BMP-2) before and 6 months after operation in the study group were higher than those in the control group (P < 0.05). The differences of Lower Extremity Functional Scale (LEFS) score and Barthel Index score before and 6 months after operation in the study group were also higher than those in the control group (P < 0.05). There was no significant difference in the femoral neck shaft angle and femoral anteversion angle between the two groups 6 months after operation (P > 0.05). Besides, there was no significant difference in the overall incidence of complications between the two groups (P > 0.05).Conclusions Non-cemented femoral prosthetic replacement combined with intraoperative reconstruction of greater trochanter is effective in treating the unstable intertrochanteric fractures. Specifically, the additional intraoperative reconstruction of the greater trochanter has more advantages in promoting fracture healing and improving hip joint function.