|
|
|
| Comparison of efficacy and hidden blood loss between anti-rotation intramedullary nail and joint replacement in the treatment of unstable intertrochanteric fractures in elderly patients |
| WANG Jianhua1 LIN Yan2 WU Yongdong1 GUO Pengcheng1 WANG Youbao1 LIAN Zhengang1 |
1.The First Department of Orthopaedics, the First Hospital of Zhangjiakou, Hebei Province, Zhangjiakou 075000, China；
2.School of Nursing, Zhangjiakou University, Hebei Province, Zhangjiakou 075000, China |
|
|
|
|
Abstract Objective To compare the efficacy and hidden blood loss of anti-rotation intramedullary nail and joint replacement in the treatment of unstable intertrochanteric fractures in elderly patients. Methods A total of 86 elderly patients with unstable intertrochanteric fractures in the First Hospital of Zhangjiakou from October 2014 to October 2016 were selected as the research objects and randomly divided into the observation group (43 cases) and the control group (43 cases) by random number table. The observation group was treated with anti-rotation intramedullary nail and the control group was treated with joint replacement. The clinical parameters of the two groups (including the operation time, postoperative drainage volume and walking time under ground load), postoperative hip function, complications and hidden blood loss were compared between the two groups. Results The operation time, postoperative drainage volume and the walking time under ground load in the observation group were lower than those of control group, with statistically significant differences(P ＜ 0.05). The scores of Harris in the observation group after operation of 1, 3, 6 months were significantly higher than those of control group, with statistically significant differences (P ＜ 0.05). The incidence of postoperative complications in the observation group(6.9%, 3/43) was lower than that of control group (27.9%, 12/43), with statistically significant difference(P ＜ 0.05). The hidden blood loss and total blood loss in the observation group were significantly lower than those of control group, with statistically significant differences (P ＜ 0.05). Conclusion The curative effect of anti-rotation intramedullary nail is better than joint replacement in the treatment of unstable intertrochanteric fracture in elderly patients and has less postoperative complications. It is worthy of popularization and promotion.
|
|
|
|
|
|
[1] 张培训，薛峰，安帅，等.股骨近端防旋髓内钉和动力髋螺钉治疗股骨粗隆间骨折的显性和隐性失血量分析[J].北京大学学报：医学版，2012，44（6）：891-894.
[2] 苏继承.骨伤科康复技术[M].北京：人民卫生出版社，2008.
[3] Nadler SB，Hidalgo JH，Bloch T. Perdiction of blood volume in normal human adults [J]. Surg，1962，51（2）：224-232.
[4] Gross JB. Estimating allowable blood loss：corrected for dilution [J]. Anesthesiology，1983，58（3）：277-280.
[5] 朱书涛，刘洋，张明辉，等.内固定物与人工半髋关节置换治疗高龄不稳定股骨粗隆间骨折的疗效分析[J].中国矫形外科杂志，2012，20（14）：1272-1274.
[6] 刘建斌，王栋，赵法章，等.PFNA治疗高龄不稳定股骨粗隆间骨折[J].中国骨质疏松杂志，2011，17（6）：529-531.
[7] 庞向华，欧兆强，欧阳建江，等.半髋关节置换与防旋型股骨近端髓内钉治疗高龄不稳定型股骨粗隆间骨折的疗效对比[J].重庆医学，2013，42（10）：1086-1088.
[8] Haidukewych GJ，Berry DJ. Salvage of failed internal fixation of intertrochanteric hip fractures [J]. Clin Orthop，2003， 412：184-188.
[9] Kaplan K，Miyamoto R，Levine BR，et al. Surgical management of hip fractures：an evidence-based review of the literature Ⅱ：intertrochanteric fractures [J]. J Am Acad Orthop Surg，2008，16（11）：665-673.
[10] Simmermacher RK，Ljungqvist J，Bai H，et al. The new proximal femoral nail antirotation（PFNA）in daily practice：results of a multicenter clinical study [J]. Injury，2008， 39（8）：932-939.
[11] 邢建瑞，李艳，杨秀丽，等.人工股骨头置换治疗高龄不稳定股骨转子间骨折[J].创伤外科杂志，2012，14（4）：350-353.
[12] 王国胜，魏宁波，曹明宇，等.人工股骨头置换与内固定治疗老年不稳定型股骨粗隆间骨折的系统评价[J].中国矫形外科杂志，2014，22（2）：121-129.
[13] 韦钊岚，李富明，程珂琳，等.防旋型股骨近端髓内钉固定与人工股骨头置换对高龄不稳定股骨粗隆间骨折的疗效比较[J].武汉大学学报：医学版，2014，35（4）：609-612.
[14] Jotanovic Z，Jurdana H，Sestan B. Hemiarthroplasty is an effective surgical method to manage unstable trochanteric fractures in elderly people [J]. Coll Antropol，2011，35（2）：427-431.
[15] 王国柱，慕会杰，努尔兰，等.人工股骨头置换治疗高龄患者股骨转子间不稳定性骨折[J].中国组织工程研究，2013，17（48）：8337-8342
[16] 叶冬平，李锋生，梁伟国，等，半髋关节置换与PFN内固定治疗高龄不稳定型股骨粗隆间骨折的疗效比较[J].中国矫形外科杂志，2009，17（18）：1371-1374.
[17] 叶伟雄，梁伟国，陈鸿辉.半髋关节置换与 DHS内固定治疗高龄不稳定型股骨转子间骨折的疗效比较[J].中国矫形外科杂志，2007，15（14）：1055-1058.
[18] Pattison E，Protheroe K，Pringle RM，et al. Reduction in haemoglobin after knee joint surgery [J]. Ann Rheum Dis，1973，32（6）：582-584.
[19] Erskine JG，Fraser C，Simpson R，et al. Blood loss with knee joint replacement [J].J R Coll Surg Edinb，1981，26（5）：295-297.
[20] 史庆轩，胡宏伟，宁廷民，等. PFNA治疗高龄股骨粗隆间骨折隐性失血的发生机制及影响因素初步分析[J].中国矫形外科杂志，2014，22（14）：1264-1265.
[21] 殷波，孙国栋，任景忠，等.微小切口PFNA治疗老年股骨粗隆间骨折的效果分析[J].中国当代医药，2015，22（19）：82-84.
[22] 洪忠，刘汉民，张州平，等.PFNA与ALP治疗老年股骨粗隆间骨折的效果比较[J].中国当代医药，2016，23（7）：101-103.
[23] Novicoff WM，Brown TE，Cui Q，et al. Mandated venous thromboembolism prophylaxis：possible adverse outcomes [J].J Arthroplasty，2008，23（1）：15-19. |
|
|
|
