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关节假体置换术在髋关节周围骨折中的应用及对骨折愈合与患肢疼痛的影响
赵亮亮,李利夫,袁京伟,李永恒,吴卫国,王冰
0
(北京市丰台中西医结合医院骨科;北京工业大学校医院骨科;北京医科大学第一附属医院骨科)
摘要:
目的 探讨关节假体置换术在髋关节周围骨折中的应用及对骨折愈合与患肢疼痛的影响。方法 选择2015年6月~2016年10月北京市丰台中西医结合医院收治的96例髋关节周围骨折患者为研究对象,按抽签法随机分为实验组和对照组,每组48例。实验组采用关节假体置换术进行治疗,对照组采用动力髋螺钉内固定术进行治疗,所有患者均给予术后常规护理,观察比较两组患者治疗后血清中骨代谢分子及骨细胞因子含量,治疗前后血清疼痛介质含量,治疗前后关节功能评分(Harris评分及LKSS评分)及术后并发症。结果 两组患者接受手术治疗1个月后,实验组患者血清中PINP、PICP的含量明显高于对照组[(26.43±3.54)vs(12.56±1.43)、(19.45±2.32)vs(10.12±1.55)],TRAP5b、GatK的含量明显低于对照组[(17.62±2.11)vs(29.21±3.67)、(9.53±1.11)vs(22.32±2.82)],差异均有统计学意义(P<0.05);实验组患者血清中骨细胞因子(BMP、TGFβ、FGF、IGF-I、IGF-II)的含量显著高于对照组[(9.32±1.12)vs(4.39±0.71)、(36.64±4.75)vs(16.56±2.23)、(1152±1.52)vs(5.13±0.65)、(8.66±0.98)vs(4.14±0.62)、(1432±1.79)vs(7.89±0.92)],差异均有统计学意义(P<0.05);治疗3、6个月后两组患者Harris评分、LKSS评分均明显提高,且实验组较对照组显著提高[(68.53±11.61)vs(56.02±12.51)、(80.01±3.82)vs(74.32±4.41);(87.14±12.72)vs(7853±10.43)、(94.27±4.79)vs(84.11±3.22)],差异均有统计学意义(P<0.05);实验组患者术后并发症发生率(10.42%)明显低于对照组(27.08%),差异有统计学意义(P<0.05)。结论 采用关节假体置换术治疗髋关节周围骨折,能够明显改善患者髋关节及膝关节功能,促进骨折愈合,明显减轻患者疼痛,减少术后并发症,值得临床推广应用。
关键词:  关节假体置换术  髋关节周围骨折  骨折愈合  患肢疼痛  术后并发症
DOI:
基金项目:北京市自然科学基金重点项目(7121012)
Application of arthroplasty in the treatment of hip fractures and its effect on fracture healing and limb pain
ZHAO Liangliang,LI Lifu,YUAN Jingwei,LI Yongheng,WU Weiguo,WANG Bing
(Department of Orthopedic, Fengtai Traditional Chinese and Western Medicine Hospital;Department of Orthopedic, Beijing Industrial University Hospital;Department of Orthopedic,The First Affiliated Hospital of Beijing Medical University)
Abstract:
Objective To investigate the application of joint prosthesis replacement in the treatment of hip fracture and its influence on fracture healing and limb pain. Methods 96 patients from June 2015 to October 2016,with hip fracture were selected and randomly divided into the experimental group and the control group, with 48 cases in each group. The experimental group was treated with joint prosthesis replacement, while the control group was treated with dynamic hip screw fixation. All patients were given routine postoperative care. The bone metabolism and bone molecule cytokine content in serum before and after treatment pain, media content, joint function before and after treatment (Harris score and LKSS score) score and postoperative complications were observed.Results The patients underwent surgery for one month. The serum levels of PINP and PICP in the serum of the two groups were significantly higher than those in the control group (26.43 ± 3.54 vs VS (1256 ± 1.43), (19.45 ± 2.32) VS (10.12 ± (29.31 ± 3.67). The content of TRAP5b and GatK was significantly lower than that of the control group [(17.62±2.11)VS(29.21±3.67),(953 ± 1.11) VS (22.32 ± 2.82)]. The difference was statistically significant (P<0.05). The serum levels of BMP, TGFβ, FGF, IGFI and IGFII in the serum of the experimental group were significantly higher than those in the control group [(9.32 ± 1.12) VS (4.39 ± 0.71), 36.64 ± 4.75 (16.36 ± 0.62), (11.32 ± 1.52) VS (5.13 ± 0.65), (8.66 ± 0.98) VS (4.14 ± 0.62) and (14.32 ± 1.79) VS (7.89 ± 0.92)]. The difference was statistically significant respectively(P<0.05). After 3 months and 6 months,compared with the control group, the scores of Harris and LKSS in the two groups were significantly higher than those in the control group[(68.53 ± 11.61) VS (56.02 ± 12.51), (80.01 ± 3.82) VS (74.32 ± 4.41); (87.14 ± 12.72) VS (78.53 ± 10.43), (94.27 ± 4.79) VS (84.11 ± 3.22)],the difference was statistically significant (P<0.05); the incidence of postoperative complications in patients in the experimental group (10.42%) than in control group (2708%). The difference was statistically significant (P<0.05).Conclusion The use of joint prosthesis replacement in the treatment of hip fractures can significantly improve the patient's hip and knee function, promote fracture healing and significantly reduce the pain of patients and postoperative complications.
Key words:  Joint prosthesis replacement  Fracture of hip joint  Fracture healing  Limb pain  Postoperative complications

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