标题：双动半髋关节置换术治疗股骨转子间骨折对髋关节功能及凝血功能的影响

      作者：马启裕，段筱勇，郭友忠    镇巴县人民医院骨科，陕西 汉中 723600

      卷次： 2020年31卷23期

      【摘要】 目的 探讨双动半髋关节置换术治疗股骨转子间骨折对患者髋关节功能及凝血功能的影响。方法 选取 2015年 1月至 2019年 8月在镇巴县人民医院治疗的股骨转子间骨折患者 112例，采用区组随机化法分为观察组和对照组，每组56例。观察组给予双动半髋关节置换术治疗，对照组给予内固定术治疗。比较两组患者的手术优良率及手术时间、术中出血量、恢复负重时间、骨愈合时间；比较两组患者手术前后的凝血功能指标[凝血酶原时间(PT)、纤维蛋白原(FIB)、D-二聚体]、Harris髋关节评分及世界卫生组织生活质量测定量表(QOL-BREF)评分。结果 观察组患者的手术优良率为96.43%，明显高于对照组的85.71%，差异有统计学意义(P<0.05)；观察组患者术后并发症发生率为3.57%，明显低于对照组的14.29%，差异有统计学意义(P<0.05)；观察组患者术后 1个月、3个月的Harris评分分别为(64.63±7.17)分、(81.48±9.12)分，明显高于对照组的(61.56±7.0)分、(77.93±9.05)分，差异均有统计学意义(P<0.05)；观察组患者术后PT值为(14.13±2.89) s，明显小于对照组的(15.24±2.83) s，FIB水平为(0.90±0.16) g/L，明显高于对照组的(0.78±0.12) g/L，D-二聚体水平为(1.35±0.15) μg/L，明显低于对照组的(1.42±0.17) μg/L，差异均有统计学意义(P<0.05)；观察组患者的手术时间为(79.86±8.75) min，明显长于对照组的(75.10±8.16) min，恢复负重时间、骨愈合时间分别为(15.32±3.85) d、(101.38±16.17) d，明显短于对照组的(17.10±4.16) d、(112.94±17.35) d，术中出血量为(186.52±38.26) mL，明显少于对照组的(204.39±39.12) mL，差异均具有统计学意义(P<0.05)；观察组患者的生理、心理、社会关系及生活环境评分分别为(28.74±2.24)分、(23.16±3.27)分、(9.13±1.74)分、(27.12±3.83)分，明显高于对照组的(27.06±2.45)分、(21.42±3.34)分、(8.18±1.59)分、(25.42±3.60)分，差异均具有统计学意义(P<0.05)。结论 双动半髋关节置换术治疗股骨转子间骨折的手术优良率较高，其可改善髋关节功能，促进骨愈合，改善凝血功能，提高生活质量。
      【关键词】 双动半髋关节置换术；股骨转子间骨折；髋关节功能；凝血功能；生活质量
      【中图分类号】 R687.4 【文献标识码】 A 【文章编号】 1003—6350（2020）23—3057—04

Effects of double-action hemiarthroplasty on hip joint function and coagulation function in the treatment ofintertrochanteric femoral fractures.
MA Qi-yu, DUAN Xiao-yong, GUO You-zhong. Department of Orthopedics,People's Hospital of Zhenba County, Hanzhong 723600, Shaanxi, CHINA
【Abstract】 Objective To observe the effects of double-action hemiarthroplasty on hip joint function and coagu-lation function in the treatment of patients with intertrochanteric femoral fractures (IFF). Methods A total of 112 IFFpatients who were treated in People's Hospital of Zhenba County between January 2015 and August 2019 were enrolled.They were divided into observation group and control group by block randomization method, with 56 patients in eachgroup. The observation group was treated with double-action hemiarthroplasty, while the control group was treated withinternal fixation. The surgical good rate, operation time, intraoperative blood loss, weight-bearing recovery time, andbone healing time were compared between the two groups. The changes in coagulation function indexes (prothrombintime [PT], fibrinogen [FIB], D-dimer [D-D]), scores of Harris hip, and Word Health Organization Quality of Life-briefVersion (QOL-BREF) before and after surgery in both groups were observed. Results The surgical good rate in obser-vation group was significantly higher than that in control group (96.43% vs 85.71%, P<0.05). The incidence of postopera-tive complications in observation group was significantly lower than that in control group (3.57% vs 14.29%, P<0.05). Har-ris scores at 1 month and 3 months after surgery in observation group were (64.63±7.17) points and (81.48±9.12) points,which were significantly higher than (61.56±7.0) points and (77.93±9.05) points in the control group (P<0.05). After sur-gery, PT in observation group was significantly lower than that in control group: (14.13±2.89) s vs (15.24±2.83) s; FIB lev-el was significantly higher than that in control group: (0.90±0.16) g/L vs (0.78±0.12) g/L; and D-dimer level was signifi-cantly lower than that in control group: (1.35±0.15) μg/L vs (1.42±0.17) μg/L; all with statistically significant differences(P<0.05). The operation time in observation group was significantly lower than that in the control group: (79.86±8.75) minvs (75.10±8.16) min; recovery time of weight-bearing and bone healing time were (15.32±3.85) d, (101.38±16.17) d,significantly shorter than (17.10±4.16) d, (112.94±17.35) d in the control group; the intraoperative blood loss was less