史图龙, 严清, 孙俊, 方晨, 汪钦, 武洵. 不同手术方式治疗股骨粗隆间骨折的疗效及术后5年内死亡因素分析[J]. 蚌埠医科大学学报, 2024, 49(9): 1179-1183. DOI: 10.13898/j.cnki.issn.1000-2200.2024.09.013
    引用本文: 史图龙, 严清, 孙俊, 方晨, 汪钦, 武洵. 不同手术方式治疗股骨粗隆间骨折的疗效及术后5年内死亡因素分析[J]. 蚌埠医科大学学报, 2024, 49(9): 1179-1183. DOI: 10.13898/j.cnki.issn.1000-2200.2024.09.013
    SHI Tulong, YAN Qing, SUN Jun, FANG Chen, WANG Qin, WU Xun. Comparison of the effects of different surgical methods in the treatment of intertrochanteric fracture and analysis of death factors within 5 years after operation[J]. Journal of Bengbu Medical University, 2024, 49(9): 1179-1183. DOI: 10.13898/j.cnki.issn.1000-2200.2024.09.013
    Citation: SHI Tulong, YAN Qing, SUN Jun, FANG Chen, WANG Qin, WU Xun. Comparison of the effects of different surgical methods in the treatment of intertrochanteric fracture and analysis of death factors within 5 years after operation[J]. Journal of Bengbu Medical University, 2024, 49(9): 1179-1183. DOI: 10.13898/j.cnki.issn.1000-2200.2024.09.013

    不同手术方式治疗股骨粗隆间骨折的疗效及术后5年内死亡因素分析

    Comparison of the effects of different surgical methods in the treatment of intertrochanteric fracture and analysis of death factors within 5 years after operation

    • 摘要: 目的: 比较不同手术方式股骨近端锁定加压钢板(PFLCP)、动力髋螺钉(DHS)和股骨近端抗旋髓内钉(PFNA)治疗股骨粗隆间骨折的临床疗效以及术后5年内死亡相关因素分析。方法: 选取146例股骨粗隆间骨折病人,按照手术方式的不同分为PFLCP组53例、DHS组29例和PFNA组64例,比较3组病人的总住院时间、术后住院时间、手术时间、术中出血量、术中及术后输血量、术后并发症、首次下地行走时间、术后3月及术后1年髋关节功能评分(Harris评分)以及术后5年内死亡率,分析术后5年内病人死亡相关因素。结果: 3组病人的总住院时间、术后住院时间、术后1年Harris评分、死亡率及术后5年失访率差异均无统计学意义(P>0.05);3组手术时间、术中出血量、术中及术后输血量、术后并发症、首次下地行走时间、术后3个月Harris评分差异均有统计学意义(P<0.05~P<0.01);PFNA组病人手术时间、术中出血量均少于PFLCP组和DHS组(P<0.05);PFNA组和DHS组术后并发症发生情况低于PFLCP组(P<0.05);PFNA组和DHS组术中及术后输血量少于PFLCP组(P<0.05);PFNA组和DHS组首次下地行走时间早于PFLCP组(P<0.05);PFNA组和DHS组术后3个月Harris评分优于PFLCP组(P<0.05)。多因素logistic回归分析显示,病人年龄、合并基础疾病、总住院时间及术后并发症与术后5年死亡情况相关(P<0.05~P<0.01)。结论: PFNA、DHS、PFLCP均可有效治疗股骨粗隆间骨折,PFNA优于PFLCP和DHS。股骨粗隆间骨折病人术后5年内死亡影响因素除年龄、基础疾病及术后并发症外,总住院时间与其死亡风险也有相关性。

       

      Abstract: Objective: To compare the clinical efficacy of proximal femoral locking compression plate(PFLCP),dynamic hip screw(DHS) and proximal femoral nail antirotation(PFNA) in the treatment of intertrochanteric fracture,and analyze the related factors of death within 5 years after surgery. Methods: A total of 146 patients with intertrochanteric fracture were divided into the PFLCP group(53 cases),DHS group(29 cases) and PFNA group(64 cases) according to different surgical methods.The total hospital stay,postoperative hospital day,operation time,intraoperative blood loss,intraoperative and postoperative blood transfusion volume,postoperative complications,first walking time,hip function score(Harris score) after 3 months and 1 year of surgery and mortality after 5 years of surgery were compared among three groups.The related factors of death within 5 years after operation were analyzed. Results: There was no statistical significance in the total hospital stay,postoperative hospital stay,Harris score after 1 year of surgery,mortality rate and loss of follow-up after 5 years of surgery among 3 groups(P>0.05).The differences of the operation time,intraoperative blood loss,intraoperative and postoperative blood transfusion volume,postoperative complications,first walking time and Harris score after 3 months of surgery among 3 groups were statistically significant(P<0.05 to P<0.01).The operative time and intraoperative blood loss in the PFNA group were lower than those in PFLCP group and DHS group(P<0.05).The incidence rates of postoperative complications in the PFNA and DHS groups were lower than that in PFLCP group(P<0.05).The intraoperative and postoperative blood transfusion volume in the PFNA and DHS groups were lower than that in PFLCP group(P<0.05).The first walking time of the PFNA and DHS groups were earlier than that of PFLCP group(P<0.05).The Harris scores of the PFNA and DHS groups were better than those of PFLCP group after 3 months of operation(P<0.05).The results of multivariate logistic regression analysis showed that the patient age,combined underlying diseases,total length of hospital stay and postoperative complications were correlated with death within 5 years after surgery(P<0.05 to P<0.01). Conclusions: PFNA,DHS and PFLCP can effectively treat intertrochanteric fracture,but the effect of PFNA is better than that of PFLCP and DHS.In addition to age,underlying disease and postoperative complications,the total length of hospital stay was also correlated with the risk of death within 5 years after operation.

       

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