强斜低位空心钉联合缝匠肌骨瓣治疗老年GardenⅢ型和Ⅳ型股骨颈骨折疗效

Therapeutic effect of strong oblique low cannulated screw fixation combined with sartorius musculoskeletal flap for Garden Ⅲ and Ⅳ femoral neck fracture in the elderly

摘要:

目的 探究强斜低位空心钉联合缝匠肌骨瓣治疗老年GardenⅢ、Ⅳ型股骨颈骨折疗效。方法 入选秦皇岛市工人医院骨科2016年6月至2017年8月老年GardenⅢ、Ⅳ型股骨颈骨折患者86例,随机数字表法分为对照组和研究组,每组43例。对照组使用常规平行加压空心钉内固定术治疗,研究组使用强斜低拉空心钉联合缝匠肌骨瓣进行治疗,比较2组患者术中指标、视觉模拟量表(VAS)评分、Harris髋关节功能评分和不良事件发生率。采用SPSS 21.0统计软件对数据进行分析。组间比较采用t检验或χ²检验。结果 对照组相比研究组手术时间[(72.56±10.48) vs(84.17±12.33)min]和术中出血量[(125.48±11.52) vs(164.72±14.89)ml]减少,差异具有统计学意义(P＜0.05)。研究组VAS评分相比对照组术后5 d[(4.82±1.02) vs(5.69±1.07)分]和10 d[(3.28±0.85) vs(4.34±0.94)分]降低,差异具有统计学意义(P＜0.05)。研究组Harris评分相比对照组术后1个月[(58.79±4.28) vs(51.25±3.63)分]、3个月[(78.46±6.47) vs(70.54±5.89)分]和6个月[(84.07±6.98) vs(79.22±6.51)分]显著高,差异具有统计学意义(P＜0.05)。对照组相比研究组不良事件发生率高[48.83%(21/43) vs 20.93%(9/43)],差异具有统计学意义(χ²＝7.371,P＝0.007)。结论 强斜低位空心钉联合缝匠肌骨瓣治疗能有效降低老年GardenⅢ、Ⅳ型股骨颈骨折患者术后疼痛,改善术后关节功能,减少不良事件发生。

Abstract:

Objective To investigate the clinical efficacy of strong oblique low position cannulated screw combined with sartorius muscle bone flap in the treatment of senile Garden Ⅲ and Ⅳ femoral neck fracture. Methods A total of 86 elderly patients with Garden Ⅲ and Ⅳ femoral neck fractures admitted in our department from June 2016 to August 2017 were recruited and randomly divided into control group (n=43) and study group (n=43). The patients of the control group were treated with conventional parallel compression cannulated screw internal fixation, and those of the study group were treated with strong oblique low tension cannulated screw combined with sartorius muscle bone flap. The intraoperative indices, visual analogue scale (VAS) score, Harris hip function score and incidence of adverse events were compared between the 2 groups. SPSS statistics 22.0 was used for data analysis. Student′s t test or Chi-square test was employed for comparison between groups. Results The control group had significantly shorter operation time [(72.56±10.48) vs (84.17±12.33)min] and less intraoperative bleeding [(125.48±11.52) vs (164.72±14.89)ml] than the study group (P<0.05). The VAS score was significantly lower in the study group than the control group on the 5th day [(4.82±1.02) vs (5.69±1.07)] and 10th day [(3.28±0.85) vs (4.34±0.94)] after operation (P<0.05). The Harris score was obviously higher in the study group than the control group in 1 month [(58.79±4.28) vs (51.25±3.63)], 3 months [(78.46±6.47) vs (70.54±5.89)] and 6 months after surgery [(84.07±6.98) vs (79.22±6.51), P<0.05]. The incidence of adverse events was notably higher in the control group than the study group [48.83%(21/43) vs 20.93%(9/43), χ²=7.371, P=0.007]. [JP+1]Conclusion Strong oblique low position cannulated screw fixation combined with sartorius muscle bone flap can effectively reducepostoperative pain, improve joint function and reduce the incidence of adverse events in the elderly patients with Garden Ⅲ and Ⅳ femoral neck fractures.