人工股骨头置换术结合快速康复理念治疗高龄不稳定型股骨转子间骨折的临床效果

目的探讨人工股骨头置换术结合快速康复理念治疗高龄不稳定型股骨转子间骨折的疗效。 方法选取赤峰市医院骨关节科2016年4月至2017年9月股骨转子间骨折患者90例，按随机数字表法分为两组，快速康复组46例，遵循围手术期循证医学证据，严格执行快速康复程序；对照组44例，沿袭传统手术管理模式。比较两组患者术后早期疼痛数字分级评分法(NRS)评分，术后输血率，恶心、呕吐发生率，口渴、饥饿、腹胀发生率，住院时间，术后2周的满意度评分，术后3个月髋关节功能Harris评分，术后并发症发生率等。对数据比较采用t检验和χ²检验。 结果术后12、24、48 h，快速康复组患者早期疼痛NRS评分分别为(3.23±1.32)、(2.42±1.51)、(1.53±1.12)分，低于对照组 (4.40±1.52)、(3.62±1.41)、(2.43±1.22)分]，差异均有统计学意义(t＝ 3.9039、3.8924、3.6481，P＝ 0.0002、0.0002、0.0004)；快速康复组患者术后输血率15.2%(5/46)，低于对照组47.7%(21/44)]，差异有统计学意义(χ²＝9.6251，P＝0.0019)；快速康复组患者术后恶心、呕吐发生率为10.9%(5/46)，低于对照组34.1%(15/44)]，差异有统计学意义(χ²＝5.7370，P＝0.0166)；快速康复组术后口渴、饥饿、腹胀发生率为13.0%(6/46)，低于对照组40.9%(18/44)]，差异有统计学意义(χ²＝7.5616，P＝0.0060)；快速康复组患者住院时间为(4.3±1.1) d，少于对照组(6.8±1.7) d]，差异有统计学意义(t＝8.3191，P<0.05)；快速康复组患者术后2周的满意度评分为(9.6±1.2)分，高于对照组(8.8±1.6)分]，差异有统计学意义(t＝2.6912，P＝0.0085)；快速康复组、对照组患者术后3个月髋关节功能Harris评分分别为(89.2±12.3)、(88.5±11.6)分，两组比较差异无统计学意义(t＝0.2775，P＝0.7821)；快速康复组患者术后并发症发生率2.2%(1/46)，低于对照组18.2%(8/44)]，差异有统计学意义(χ²＝4.7480，P＝0.0293)。 结论采用人工股骨头置换术结合快速康复理念治疗高龄股骨转子间骨折，可缩短患者住院时间，使患者快速恢复日常活动，提高患者满意度，是一种安全可靠的选择。

Clinical effect of artificial femoral head replacement combined with fast tract surgery in the treatment of aged unstable femoral intertrochanteric fractures patients

ObjectiveTo evaluate the effect of artificial femoral head replacement combined with fast tract surgery in the treatment of aged unstable femoral intertrochanteric fractures patients. MethodsNinety patients with femoral intertrochanteric fractures of the Department of Joint Surgery, Chifeng Municipal Hospital from April 2016 to September 2017 were divided into fast track group and control group according to the random number table method. The fast track group (n=46) was established by the evidence based medicine in the perioperative period and strictly implement the fast track rehabilitation program. In control group (n=44), conventional surgical management mode was followed. The early postoperative pain numerical rating scale (NRS) score, blood transfusion rate, nausea and vomiting incidence, thirst, hunger and abdominal distension incidence rate, hospitalization time, the satisfaction of 2 weeks after operation, 3 months′ Harris score after operation, and the incidence of postoperative complications were compared between the two groups. The data were analyzed by t test and chi-square test. ResultsAt 12, 24, and 48 h after operation, the NRS score of patients in the fast track group were (3.23±1.32), (2.42±1.51), (1.53±1.12) points, which were lower than those in the control group (4.40±1.52), ( 3.62 ± 1.41), (2.43 ± 1.22) points], the differences were statistically significant (t= 3.9039, 3.8924, 3.6481, P=0.0002, 0.0002, 0.0004); postoperative blood transfusion rate was 15.2%(5/46) in the fast track group, it was considerably lower than the 47.7%(21/44) in control group, the difference was statistically significant (χ²=9.6251, P=0.0019). The incidence of postoperative nausea and vomiting was 10.9% (5/46) in the fast track group, which was lower than that in the control group 34.1% (15/44)], the difference was statistically significant (χ²=5.7370, P=0.0166). The rate of thirst, hunger, and bloating in the fast track group was 13.0% (6/46), which was lower than that in the control group 40.9% (18/44)], the difference was statistically significant (χ²=7.5616, P=0.0060). The hospitalization time in patients of the fast track group was (4.3±1.1) days, which was less than that of the control group (6.8±1.7) days]. The difference was statistically significant (t=8.3191, P<0.05). The patients′ satisfaction degree at 2 weeks after operation in the fast track group was (9.6±1.2) points, which was higher than that of the control group (8.8±1.6) points], the difference was statistically significant (t=2.6912, P=0.0085). The hip function Harris scores were (89.2±12.3) and (88.5±11.6) points in the fast track group and control group at 3 months postoperatively, there was no significant difference between the two groups (t=0.2774, P=0.7821). The incidence of complications in the fast track group was 2.2%(1/46), which was lower than that in the control group 18.2%(8/44)], the difference was statistically significant (χ²=4.7480, P=0.0293). ConclusionsThe use of artificial femoral head replacement combined with the concept of fast tract surgery for the treatment of femoral intertrochanteric fractures in the elderly can shorten the length of hospital stay, enable patients to quickly restore daily activities, and improve patient satisfaction. It is a safe and reliable choice.