差異性體位優化對老年肥胖股骨粗隆間骨折患者PFNA內固定治療效果的研究

【摘要】 目的：研究差異性體位優化對老年肥胖股骨粗隆間骨折患者股骨近端防旋髓內釘（PFNA）內固定的治療效果。方法：選取80例2019年1月—2021年12月龍南市第一人民醫院收治的擬行PFNA內固定治療的老年肥胖股骨粗隆間骨折患者開展研究。將其按照電腦編號隨機法分作側臥位組及仰臥位組，每組40例。側臥位組使用側臥體位開展手術，仰臥位組使用仰臥體位開展手術。分析兩組手術指標、髖關節功能、應激反應及骨代謝指標4個方面的差異。結果：側臥位組手術時長及術后首次下床活動時間均短于仰臥位組，且術中出血量及透視次數均少于仰臥位組（Plt;0.05）。術后1周側臥位組去甲腎上腺素（NE）及血管緊張素Ⅱ（AngⅡ）均低于仰臥位組（Plt;0.05）。術后3個月，側臥位組血清Ⅰ型前膠原氨基末端前肽（PⅠNP）及甲狀旁腺激素（PTH）均高于仰臥位組（Plt;0.05）。術后1年兩組Harris髖關節功能評分均顯著提高（Plt;0.05）；側臥位組略高于仰臥位組，但組間差異無統計學意義（Pgt;0.05）。結論：相較于仰臥位而言，側臥位下開展PFNA內固定治療老年肥胖股骨粗隆間骨折患者的效果更佳，且有效減輕應激反應，改善骨代謝指標表達。

【關鍵詞】 肥胖 股骨粗隆間骨折 側臥位 仰臥位

Study on the Effect of Different Position Optimization on PFNA Internal Fixation in Elderly Obese Patients with Intertrochanteric Fracture of Femur/TANG Shaojun. //Medical Innovation of China， 2023， 20（31）： -129

[Abstract] Objective： To study the effect of different position optimization on proximal femoral nail anti-rotation （PFNA） internal fixation in elderly obese patients with intertrochanteric fracture of femur. Method： A total of 80 elderly obese patients with intertrochanteric fracture of femur who were admitted to the First People's Hospital of Longnan from January 2019 to December 2021 and planned to be treated with PFNA internal fixation were selected for the study. The patients were randomly divided into the lateral position group and the supine position groups according to the computer numbering method， with 40 cases in each group. The lateral position group was operated in the lateral position， and the supine position group was operated in the supine position. The differences of operative indexes， hip function， stress response and bone metabolism indexes between the two groups were analyzed. Result： The operation time and the first of postoperative ambulation time in the lateral position group were shorter than those in the supine position group， and the intraoperative blood loss and fluoroscopy times were less than those in the supine position group （Plt;0.05）. The norepinephrine （NE） and angiotensin Ⅱ （AngⅡ） in the lateral position group were lower than those in the supine position group at 1 week after operation （Plt;0.05）. At 3 months after operation， the serum procollagen type Ⅰ N-terminal propeptide （PⅠNP） and parathyroid hormone （PTH） in the lateral position group were higher than those in the supine position group （Plt;0.05）. At 1 year after surgery， the hip Harris scores of both groups was significantly increased （Plt;0.05）， the lateral position group was slightly higher than the supine position group， but there was no significant difference between two groups （Pgt;0.05）. Conclusion： Compared with supine position， PFNA internal fixation in lateral position has a better effect in the treatment of elderly obese intertrochanteric fracture of femur patients， and it can effectively reduce stress response and improve the expression of bone metabolism indicators.

[Key words] Obesity Intertrochanteric fracture of femur Lateral position Supine position

First-author's address： The First People's Hospital of Longnan， Jiangxi Province， Longnan 341700， China

doi：10.3969/j.issn.1674-4985.2023.31.029

隨著國民生活水平的持續改善及飲食結構的日益變化，肥胖老年人占比開始呈逐年攀升趨勢[1]。股骨粗隆間骨折是多發生于老年人群的骨科疾病之一，目前臨床上治療該病的主要原則為以手術完成早期復位固定，從而促進患者髖關節功能的改善[2]。股骨近端防旋……