2019 年第 2 期 第 14 卷

亚洲型股骨近端防旋髓内钉治疗对股骨转子间骨折患者髋关节功能和凝血功能的影响

Effect of Asian proximal femoral nail anti-rotation on hip joint function and coagulation function in patients with intertrochanteric femur fracture

作者：路晓灵陈良

英文作者：

单位：315010浙江省宁波市第二医院骨科

英文单位：

关键词：股骨转子间骨折；亚洲型股骨近端防旋髓内钉；凝血功能；髋关节功能

英文关键词：

• 摘要：

• 【摘要】目的    探讨股骨转子间骨折（IFF）患者采用亚洲型股骨近端防旋髓内钉（PFNA-Ⅱ）治疗对凝血功能和髋关节功能的影响。方法    选取2015年11月至2017年1月浙江省宁波市第二医院手术治疗的IFF患者90例，根据手术方法分为PFNA组（45例）和动力髋螺钉（DHS）组（45例）。对比2组患者的手术相关指标、凝血功能、血栓弹力图指标、髋关节功能。结果    PFNA组手术时间、出血量、切口大小、骨折愈合时间明显短于/少于/小于DHS组，差异均有统计学意义（均P＜0.01）。术前，2组凝血功能指标、血栓弹力图指标差异均无统计学意义（均P＞0.05）；术后3 d，PFNA组活化部分凝血酶时间、凝血酶时间、凝血酶原时间测定值明显高于DHS组［（48.8±2.8）s比（45.0±3.1）s、（19.4±1.2）s比（18.3±1.5）s、（17.1±1.8）s比（15.5±1.5）s］，纤维蛋白原、D-二聚体测定值均明显低于DHS组［（4.0±0.7）g/L比（4.5±0.9）g/L、（0.19±0.07）mg/L比（0.23±0.09）mg/L］；PFNA组R值、K值测定值明显大于DHS组［（4.9±0.9）min比（4.4±0.8）min、（1.60±0.11）min比（1.52±0.13）min］，α角测定值明显小于DHS组［（68±8）°比（75±9）°］，差异均有统计学意义（均P＜0.01）。术后4个月，PFNA组患者的髋关节功能评价明显优于DHS组（Z＝－2.012，P＝0.044）。2组手术并发症发生率差异无统计学意义（P＝0.238）。结论    IFF患者采用PFNA-Ⅱ治疗手术效果可靠、术后康复快、对患者凝血功能影响小。

• 【Abstract】Objective    To investigate the effect of Asian proximal femoral nail anti-rotation(PFNA-Ⅱ) on coagulation function and hip joint function in patients with intertrochanteric femur fracture（IFF）. Methods    From November 2015 to January 2017, 90 IFF patients in Ningbo No.2 Hospital were allocated to have PFNA surgery（PFNA group, n＝45） and dynamic hip screw（DHS） surgery（DHS group, n＝45）. Surgical data, coagulation function, thrombelastogram and hip joint function were analyzed. Results    Operation time, bleeding volume, incision size and fracture healing time in the PFNA group were significantly shorter/less than those in the DHS group(P＜0.01). Before surgery, coagulation function and thrombelastogram indexes were similar between groups（P＞0.05）. Three days after surgery, values of activated partial thromboplastin time, thrombin time and prothrombin time in the PFNA group were significantly higher than those in the DHS group［（48.8±2.8）s vs （45.0±3.1）s, （19.4±1.2）s vs （18.3±1.5）s, （17.1±1.8）s vs （15.5±1.5）s］; levels of fibrinogen and D-dimer in the PFNA group were significantly lower than those in the DHS group［（4.0±0.7）g/L vs （4.5±0.9）g/L, （0.19±0.07）mg/L vs （0.23±0.09）mg/L］; R value and K value in the PFNA group were significantly higher than those in the DHS group［（4.9±0.9）min vs （4.4±0.8）min, （1.60±0.11）min vs （1.52±0.13）min］; α angle in the PFNA group was significantly less than that in the DHS group［（68±8）° vs （75±9）°］（all P＜0.01）. Four months after surgery, hip function evaluation satisfactory effect, in the PFNA group was significantly better than that in the DHS group（Z＝－2.012， P＝0.044）. Incidence of complications showed no significant difference between groups（P＝0.238）. Conclusion    PFNA-Ⅱ surgery shows rapid postoperative recovery and few effect on coagulation function in IFF patients.