Effect of percutaneous plucking reduction and internal fixation technology on the levels of NE and Ang Ⅱ and hip joint function in elderly patients with irreversible intertrochanteric fractures

doi:10.3877/cma.j.issn.2096-0263.2021.01.003

Abstract

Abstract:

Objective

To investigate the effect of percutaneous plucking reduction and internal fixation technology on the levels of norepinephrine (NE) and angiotensin II receptor antagonist, AngⅡ (AngⅡ) and hip joint function in elderly patients with irreversible intertrochanteric fractures.

Methods

A total of 102 elderly patients with irreversible intertrochanteric fractures treated in our hospital between January 2018 and January 2020 were selected and divided into the control group (n=51) and the observation group (n=51) according to the random number table method. The control group was treated with open reduction and internal fixation, and the study group was treated with percutaneous prying PFNA closed reduction and internal fixation technology. The two groups were followed up for 2 months after operation. The operation-related indicators, the hip joint excellent rate and complications between the two groups were compared, the levels of serum NE and AngⅡ before and after 1 day after operation between the two groups were compared; the score of Harris 1, 2 months after operation were calculated.

Results

The operation time (46±4) min, incision length (5.0± 0.5) cm and hospital stay (11.1±1.6) d in the study group were shorter than that in the control group [(78±6) min; (12.6±1.4) cm; (12.9 ±2.8) d, t=31.137, 37.955, 4.039, P<0.05)], intraoperative blood loss (132±27) mL was less than the control group [(156±25) mL, t=4.715, P<0.05)]. The excellent and good hip joint rate in the study group at 1 and 2 months after surgery were 80.39% and 94.12%, which were higher than the control group at 60.79% and 68.63% (t=8.421, 9.314, P<0.05). Compared with preoperation, the score of Harris in both groups showed a gradually increasing trend at 1 and 2 months post-operation (F=11.537, 15.458, P<0.05), and the study group were higher than the control group at 1 and 2 months after operation (F=5.824, 3.736, P<0.05). Compared with preoperation, the levels of serum NE and AngⅡ increased in the two groups after 1 day (study group, t=19.396, 12.789, control group, t=41.450, 17.143, P<0.05), and the study group were lower than the control group (t=22.705, 4.683, P<0.05). The incidence of complications in the study group was 5.88%, which was lower than the 11.76% in the control group (χ²=4.126, P<0.05).

Conclusion

Percutaneous prying PFNA closed reduction internal fixation technology can improve the surgical indicators of elderly patients with irreversible intertrochanteric fractures, and can reduce the serum NE and Ang Ⅱ levels of patients and reduce fracture injuries, thereby helping to enhance the hip function of patients, improve the excellent rate of hip joints, and have higher safety.

Key words: Femoral fractures, Percutaneous reduction and internal fixation, Hip function, Norepinephrine, Angiotensin Ⅱ

Jianhua Wang, Yan Lin, Yongdong Wu, Youbao Wang. Effect of percutaneous plucking reduction and internal fixation technology on the levels of NE and Ang Ⅱ and hip joint function in elderly patients with irreversible intertrochanteric fractures[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(01): 9-14.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlngkykfdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-0263.2021.01.003

https://zhlngkykfdzzz.cma-cmc.com.cn/EN/Y2021/V07/I01/9

Figures/Tables 6

References 20

1	Min BW, Lee KJ, Oh JK, et al. The treatment strategies for failed fixation of intertrochanteric fractures [J]. Injury, 2019, 50(7): 1339-1346.
2	Chen J, Ma JX, Wang Y, et al. Correction to: finite element analysis of two cephalomedullary nails in treatment of elderly reverse obliquity intertrochanteric fractures: zimmer natural nail and proximal femoral nail antirotation-ΙΙ [J]. J Orthop Surg Res, 2020, 15(1): 98.
3	Maroun G, Chaftari R, Chokr J, et al. High comorbidity index is not associated with high morbidity and mortality when employing constrained arthroplasty as a primary treatment for intertrochanteric fractures in elderly patients [J]. Eur J Orthop Surg Traumatol, 2019, 29(5): 1009-1015.
4	Morvan A, Boddaert J, Cohen-Bittan J, et al. Risk factors for cut-out after internal fixation of trochanteric fractures in elderly subjects.[J]. Orthop Traumatol Surg Res, 2018, 104(8): 1183-1187.
5	邱元洲，高彦军，王士波，等. 经皮撬拨复位外支架固定治疗跟骨骨折的疗效及学习曲线[J]. 中国中医骨伤科杂志，2020，28(1): 71-74.
6	李明东，陈剑飞，马业涛，等. 牵引床仰卧位与非牵引床侧卧位PFNA手术治疗股骨粗隆间骨折疗效比较[J]. 中国修复重建外科杂志，2020，34(1): 32-36.
7	张昌军，戴磊，王宪卫. PFNA内固定治疗老年股骨粗隆间骨折术后5年随访结果分析[J]. 中国骨与关节损伤杂志，2019，34(12): 1285-1287.
8	Ong-Art P, Thipachart P, Yanin P, et al. Proximal femoral nail anti-rotation with cement augmentation reduces the prevalence of mechanical failure for intertrochanteric fracture in elderly patient:a preliminary study [J]. Osteo and Sarc, 2019, 10(1): 12-17.
9	Buell TJ, Yener U, Wang TR, et al. Sacral insufficiency fractures after lumbosacral arthrodesis: salvage lumbopelvic fixation and a proposed management algorithm [J]. J Neurosurg Spine, 2020, 27(1): 1-12.
10	Manson TT. Open reduction and internal fixation plus total hip arthroplasty for the acute treatment of older patients with acetabular fracture: surgical techniques [J]. Orthop Clin North Am, 2020, 51(1): 13-26.
11	Magill HHP, Hajibandeh S, Bennett J, et al. Open reduction and internal fixation versus primary arthrodesis for the treatment of acute lisfranc injuries: a systematic review and meta-analysis [J]. J Foot Ankle Surg, 2019, 58(2): 328-332.
12	高金华，王明洋，顾文浩，等. 经皮撬拨复位PFNA内固定和股骨近端解剖锁定板内固定治疗老年不稳定股骨粗隆间骨折的疗效比较[J]. 中国骨与关节损伤杂志，2017，32(6): 619-620.
13	郭团茂，翟红兵，陈文恒，等. 采用三种手术方法治疗老年骨质疏松性股骨粗隆间骨折疗效比较[J]. 中国临床医生杂志，2020，48(2): 205-207.
14	孙思炜，赵庆国，谭成龙，等. 跟骨骨折经皮微创撬拨复位内固定手术治疗对患者术后并发症发生的影响[J]. 解放军预防医学杂志，2019，37(11): 124-125，127.
15	Zhou S, Liu J, Zhen P, et al. Proximal femoral nail anti-rotation versus cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture in the elderly: a retrospective study [J]. BMC Musculoskelet Disord, 2019, 20(1): 500.
16	Tsuji H, Takigawa T, Misawa H, et al. Minimally invasive percutaneous spinopelvic fixation for unstable pelvic ring fracture performed with the patient in a lateral position[J]. Clin Spine Surg, 2019, 32(5): 191-197.
17	刘冰，赵亮亮，朱云龙，等. DHS、PFNA内固定治疗老年股骨粗隆间骨折的临床疗效及安全性分析[J]. 中国医刊，2017，52(7): 84-87.
18	范运强. 不同手术方式对胫骨远端骨折患者的创伤反应程度及成骨-破骨平衡的影响[J]. 海南医学院学报，2017，23(1): 100-103.
19	赵鹏，李东亮，杨飞，等. 难复位性股骨粗隆间骨折的影像学特点及手术疗效[J]. 中国骨伤，2016，29(8): 693-696.
20	Manohara R, Reid JT. Percutaneous endobutton fixation of acute acromioclavicular joint injuries and lateral clavicle fractures [J]. J Clin Orthop Trauma, 2019, 10(3): 492-496.

组别	例数	性别（例，男性/女性）	年龄（岁，±s）	病程（d，±s）	体重指数（kg/m²，±s）	骨折原因（例，坠伤/车祸）
对照组	51	29/22	76.57±4.11	5.89±1.35	23±0.1	25/26
观察组	51	27/24	79.96±5.00	5.73±1.05	23±0.2	31/20
统计值		χ²=0.041	t=0.430	t=0.668	t=0.322	χ²=0.556
P值		>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	性别（例，男性/女性）	年龄（岁，±s）	病程（d，±s）	体重指数（kg/m²，±s）	骨折原因（例，坠伤/车祸）
对照组	51	29/22	76.57±4.11	5.89±1.35	23±0.1	25/26
观察组	51	27/24	79.96±5.00	5.73±1.05	23±0.2	31/20
统计值		χ²=0.041	t=0.430	t=0.668	t=0.322	χ²=0.556
P值		>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	手术时间（min）	术中出血量（mL）	切口长度（cm）	住院时间（d）
研究组	51	46±4	132±27	5.0±0.5	11.1±1.6
对照组	51	78±6	156±25	12.6±1.4	12.9±2.8
t值		31.137	4.715	37.955	4.039
P值		<0.001	<0.001	<0.001	<0.001

组别	例数	手术时间（min）	术中出血量（mL）	切口长度（cm）	住院时间（d）
研究组	51	46±4	132±27	5.0±0.5	11.1±1.6
对照组	51	78±6	156±25	12.6±1.4	12.9±2.8
t值		31.137	4.715	37.955	4.039
P值		<0.001	<0.001	<0.001	<0.001

组别	例	术后1个月的髋关节优良率					术后2个月后髋关节优良率
组别	数	优	良	可	差	优良率	优	良	可	差	优良率
研究组	51	16（31.37）	25（49.02）	5（9.80）	5（9.80）	41（80.39）	18（35.29）	30（58.82）	2（3.92）	1（1.96）	48（94.12）
对照组	51	11（21.57）	20（39.22）	15（29.41）	5（9.80）	31（60.79）	9（17.65）	26（50.98）	11（21.57）	5（9.80）	35（68.63）
χ²值		8.421					9.314
P值		0.004					0.002

Please choose a citation manager

Content to export