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中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 528 -532. doi: 10.3877/cma.j.issn.1674-134X.2021.05.002

临床论著

比较一期与分期手术治疗股骨转子间骨折合并椎体骨折
李奇伟1, 林涨源2,()   
  1. 1. 417000 长沙,湖南省脑科医院(湖南省第二人民医院)手足外科
    2. 410013 长沙,中南大学湘雅医院骨科
  • 收稿日期:2021-09-18 出版日期:2021-10-01
  • 通信作者: 林涨源

Comparison of one-stage and two-stage operations in treatment of intertrochanteric fracture combining vertebral compression fracture

Qiwei Li1, Zhangyuan Lin2,()   

  1. 1. Department of Hand and Foot Surgery, Hunan Brain Hospital (Hunan Second People′s Hospital), Changsha 417000, China
    2. Department of Osteology, Xiangya Hospital, Central South University, Changsha 410013, China
  • Received:2021-09-18 Published:2021-10-01
  • Corresponding author: Zhangyuan Lin
引用本文:

李奇伟, 林涨源. 比较一期与分期手术治疗股骨转子间骨折合并椎体骨折[J/OL]. 中华关节外科杂志(电子版), 2021, 15(05): 528-532.

Qiwei Li, Zhangyuan Lin. Comparison of one-stage and two-stage operations in treatment of intertrochanteric fracture combining vertebral compression fracture[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(05): 528-532.

目的

分析股骨转子间骨折合并椎体压缩骨折行一期手术或分期手术治疗的效果的差异。

方法

回顾2018年6月至2020年6月湖南省脑科医院收治的股骨转子间骨折合并椎体压缩骨折患者。纳入标准:单侧肢体EvansⅠ~Ⅳ型股骨转子间骨折,受伤后24 h内行股骨近端防旋型髓内钉(PFNA)手术治疗,脊柱椎体Ⅰ~Ⅱ度压缩性骨折;排除标准:既往发生过髋部骨折,受伤前3个月内发生过脊柱椎体压缩性骨折,受伤前存在肢体全瘫或不全瘫,椎体爆裂性骨折,病理性骨折,累及2个或更多节椎体的压缩性骨折。根据患者实施脊柱椎体后凸成形术(PKP)的时机,分为2组。一期手术组:同台手术依次进行PFNA术、PKP术;分期手术组:首先施行PFNA术,PFNA术后3 d内限期行PKP术。分析患者的年龄、性别构成、术前背部疼痛视觉模拟评分法(VAS)评分和老年髋部骨折后的功能独立评分(FIM)评分,术后分析PFNA术耗时、PFNA术中出血量、术后6个月FIM评分、PKP术耗时、PKP术后背部疼痛VAS评分,并比较2组患者住院时长、住院总费用的差异。对于性别构成、基础疾病等计数资料,采用卡方检验或Fishers确切概率法比较;对于术前FIM评分、PFNA手术耗时、术后6个月FIM评分、住院总费用,行t检验;对于年龄、术前背部疼痛VAS评分、PFNA术中出血量、PKP术耗时、PKP术后背部疼痛VAS评分、住院时长,采用Mann-Whitney U秩和检验进行比较。

结果

本研究共纳入研究对象67例,一期手术组39例、分期手术组28例,2组患者的年龄[分别为69(66,74)岁、73(67,76)岁,Z=1.601]、性别比例( χ2=2.975)、术前背部疼痛VAS评分[分别为4(2,4)、4(2,4),Z=-0.728]、术前FIM评分[分别为(61±5)、(59±5),t=1.506]基本一致,差异均无统计学意义(均为P>0.05)。一期手术组在PFNA术耗时(分别为(57.69±10.81)min、(62.54±12.69)min,t=-1.682)、PFNA术中出血量(分别为100.00(100.00,150.00)ml、100.00(50.00,100.00)ml,Z=-1.076)、术后6个月FIM评分[分别为(118.41±11.15)、(114.89±10.48),t=1.306]方面,与分期手术组患者的差异无统计学意义(均为P>0.05);施行PKP术所耗时间[分别为20.00(15.00,25.00)min、20.00(15.00,20.00)min,Z=-1.108)]、PKP术后背部疼痛VAS评分[分别为0(0,1.00)、0(0,1.00),Z=-0.786]亦较相近,差异无统计学意义;但是一期手术组患者的住院时长更短[分别为7.00(6.00,7.00)d, 11.00(9.50,12.50)d,Z=-6.280]、住院总费用较低[分别为(4.90±0.21)万元、(5.16±0.25)万元,t=-4.486],差异具有统计学意义(均为P<0.05)。

结论

对于股骨转子间骨折合并椎体压缩骨折患者,一期或分期手术行PFNA术、PKP术,术后恢复及疼痛改善情况基本一致,但一期手术可以降低住院时长、减少住院费用。

Objective

To analyze the difference in the effect of one-stage operation or staged operation for intertrochanteric fracture complicated with vertebral compression fracture.

Methods

The patients with intertrochanteric fracture complicated with vertebral compression fracture admitted to Hunan Brain Hospital from June 2018 to June 2020 were reviewed. Inclusion criteria: unilateral Evans Ⅰ-Ⅳ intertrochanteric fracture of the limb, proximal femoral anti-rotation intramedullary nail (PFNA) surgery within 24 h after injury, Ⅰ-Ⅱ degree compression fracture of the vertebral body. Exclusion criteria: previous hip fracture, spinal vertebral compression fracture within three months prior to injury, total or incomplete limb palsy prior to injury, vertebral burst fracture, pathological fracture, and compression fracture involving two or more vertebrae. According to the timing of spinal kyphoplasty (PKP), the patients were divided into two groups. One-stage operation group: PFNA and PKP were performed successively at the same stage; staged operation group: PFNA was performed first, and PKP was performed within three days after PFNA. Age, gender composition, visual analogue scale (VAS) score for preoperative back pain and functional independent score (FIM) score for elderly hip fracture were analyzed. Postoperative PFNA duration, PFNA intraoperative blood loss, postoperative six months FIM score, PKP duration, and VAS score for PKP postoperative back pain were analyzed. The length of hospitalization and total hospitalization cost were compared between the two groups. Chi-square test or Fishers exact test were used to compare the counting data such as gender ratio and previous diseases; t test was performed to analyze preoperative FIM score, time-consuming on PFNA procedure, six-month postoperative FIM score, and total cost of hospitalization; Mann-Whitney U test was used for comparison for the age, VAS scores of preoperative back pain, intraoperative blood loss of PFNA, the duration and VAS scores of postoperative back pain of PKP, and length of hospital stay.

Results

A total of 67 patients were included in this study, including 39 patients in the primary surgery group and 28 patients in the staged surgery group. The age of patients in the two groups [69 (66, 74) years, 73 (67, 76) years, Z=1.601], the sex ratio ( χ2=2.975), preoperative back pain VAS scores [4 (2, 4), 4 (2, 4), Z=-0.728], preoperative FIM scores[ (61±5), (59±5), t=1.506] were basically the same. There was no significant difference (P>0.05). PFNA operation time (57.69±10.81) min, (62.54±12.69) min, t=-1.682), intraoperative PFNA blood loss [100.00(100.00, 150.00)ml, 100.00(50.00, 100.00)ml, Z=-1.076], FIM score six months after operation [(118.41±11.15), (114.89±10.48), t=1.306], there was no statistically significant difference between the patients and the staging operation group (P>0.05). The duration of PKP operation [20.00(15.00, 25.00)min, 20.00(15.00, 20.00)min, Z=-1.108] and the VAS score of back pain after PKP operation [0(0, 1.00), 0(0, 1.00), Z=-0.786] showed no statistically significant difference. The patients in the primary surgery group had shorter length of hospital stay [7.00 (6.00, 7.00) d, 11.00(9.50, 12.50) d, Z=-6.280] and lower total hospitalization cost [(4.90±0.21) ten thousand CNY, (5.16±0.25) ten thousand CNY, t=-4.486]. The differences were statistically significant (all P<0.05).

Conclusion

For patients with intertrochanteric fractures of femur combined with vertebral compression fractures, PFNA and PKP are similar in postoperative recovery and pain improvement by one-stage or staged operations, but the length of hospital stay and hospitalization cost can be reduced by staged operation.

表1 分期与一期手术患者一般情况及术前情况比较
表2 分期与一期手术患者既往慢性疾病[例(%)]
表3 分期与一期手术患者术后情况及住院时长、总费用比较
[1]
Alexiou KI, Roushias A, Varitimidis SE, et al. Quality of Life and psychological consequences in elderly patients after a hip fracture: a review[J]. Clin Interv Aging, 2018, 13(1): 143-150.
[2]
Bhandari M, Swiontkowski M. Management of acute hip fracture[J]. N Engl J Med, 2017, 377(21): 2053-2062.
[3]
Veronese N, Maggi S. Epidemiology and social costs of hip fracture[J]. Injury, 2018, 49(8): 1458-1460.
[4]
王伟,汤同军,丁骁鹏,等. 骨质疏松性椎体压缩性骨折治疗进展研究[J]. 江苏科技信息202138(8):52-55.
[5]
李炜虹,吴斌,李煜明.骨质疏松症药物治疗的进展[J/CD].中华关节外科杂志(电子版)20137(3):416-419.
[6]
胡洁芬,陈懿,吴文.双膦酸盐的发展及临床应用[J/CD].中华关节外科杂志(电子版)20137(2):265-268.
[7]
及松洁,Je CY, 程志远,等.双膦酸盐相关非典型股骨骨折的手术治疗[J].中国骨质疏松杂志20139(11):1165-1169.
[8]
王鑫,徐小龙.双膦酸盐的分子生物学机制及临床应用进展[J/CD].中华关节外科杂志(电子版)20159(1):120-122.
[9]
叶亚罡.PFNA结合抗骨质疏松药物治疗老年股骨粗隆间骨折的临床效果[J].临床医学202141(5):64-65.
[10]
李秋江,房晓敏,王胤斌,等.骨质疏松性椎体压缩性骨折椎体强化术后椎体再骨折的相关因素[J].中华骨质疏松和骨矿盐疾病杂志202114(3):252-260.
[11]
张海明,张金喜,金昕.椎体压缩性骨折患者术后再发骨折的影响因素分析[J].浙江创伤外科202126(3):438-439.
[12]
姜洪池,孙备,王刚.快速康复外科的新理念值得重视[J].中华外科杂志200745(9):577-579.
[13]
吴茜,陈静娟,沈蓉蓉,等.多学科合作快速康复外科模式中护理的作用[J].中国护理管理201414(2):215-218.
[14]
朱桂玲,孙丽波,王江滨,等.快速康复外科理念与围手术期护理[J].中华护理杂志200843(3):264-265.
[15]
刘功稳,高焱,徐又佳. 髋部骨质疏松性骨折48小时手术的临床意义[J]. 中华骨科杂志201939(17):1096-1100.
[16]
甘泉. 经伤椎椎弓根植骨联合椎弓根钉内固定系统治疗胸腰椎爆裂性骨折的效果[J]. 中外医学研究202119(18):122-124.
[17]
黄永恒,刘星,尚显文. 骨质疏松性椎体压缩性骨折患者PKP治疗后发生邻近椎体骨折的危险因素分析[J]. 山东医药202161(23):72-76.
[18]
李秋江,房晓敏,王胤斌,等. 骨质疏松性椎体压缩性骨折椎体强化术后椎体再骨折的相关因素[J]. 中华骨质疏松和骨矿盐疾病杂志202114(3):252-260.
[19]
王亮亮,黄成,戴永平,等. 椎体后凸成形术治疗老年胸腰椎压缩性骨折的临床疗效及再骨折影响因素分析[J]. 创伤外科杂志202022(5):340-344.
[20]
胡兆云.探讨全身麻醉与椎管内麻醉对高龄股骨粗隆间骨折患者术后恢复效果的影响[J/CD].临床医药文献电子杂志20207(68):67-68.
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