| 摘要: |
| 目的：探讨全髋关节置换术与动力髋螺钉内固定术两种治疗方法对移位型股骨颈骨折髋关节功能及对血清炎性因子和骨折延迟愈合生化指标的影响。方法：选取 2014 年 7 月—2016 年 7 月该院收治 100 例移位型股骨颈骨折患者的临床资料进行回顾性分析，将行全髋关节转换术患者 52 例做为观察组，行髋螺钉内固定术患者 48 例做为对照组，对比分析两组患者治疗前与术后 12 个月时髋关节功能改良 Aubigné-Postel 评分和并发症发生情况，及手术前与手术后 1 周血清白细胞介素 -6（IL-6）、肿瘤坏死因子 -α（TNF-α）、白细胞介素 -1β（IL-1β）等炎性因子、术后 12 周血清胰岛素样生长因子 -1（IGF-1）、人可溶性细胞间黏附分子 -1（sICAM-1）、血清可溶性血管细胞黏附分子 -1（Svcam-1）、Ⅰ型胶原羧基端肽β 特殊序列（β-CTX）等骨折延迟愈合生化指标水平。结果：术后 12 个月观察组髋关节功能改良 Aubigné-Postel 评分优良率（82.96%）明显高于对照组同期评分优良率（62.50%），比较差异有统计学意义（P<0.05）；两组术后 12 个月，观察组并发症发生率 1.92%（1 例），明显低于对照组 29.17%（14 例），比较差异有统计学意义（P<0.05）；治疗前观察组IL-6、TNF-α、IL-1β 水平分别为（9.8±1.1）pg/mL、（2.3±0.4）ng/mL、（2.9±0.3）pg/mL，对照组分别为（9.9±1.2）pg/mL、（2.2±0.4）ng/mL、（2.8±0.3）pg/mL，比较差异无统计学意义（P>0.05）；治疗后 1 周，两组 IL-6、TNF-α、IL-1β 水平均明显上升，观察组分别为（11.1±1.3）pg/mL、（3.2±0.4）ng/mL、（3.2±0.4）pg/mL，对照组分别为（15.2±1.5）pg/mL、（5.5±0.5）ng/mL、（5.7±0.6）pg/mL，两组比较，观察组明显低于对照组，比较差异有统计学意义（P<0.05）；治疗前观察组血清胰岛素样生长因子 -1（IGF-1）、血清可溶性血管细胞黏附分子 -1（Svcam-1）、Ⅰ型胶原羧基端肽 β 特殊序列（β-CTX）分别为（207.2±44.1）ng/mL、（913.2±55.2）ng/mL、（458.6±32.5）pg/mL，对照组分别为（205.9±43.7）ng/mL、（908.6±54.7）ng/mL、（461.3±29.7）pg/mL，比较差异无统计学意义（P>0.05）；治疗后 12 周，观察组 IGF-1、Svcam-1、β-CTX 分别为（338.1±53.3）ng/mL、（611.3±44.6）ng/mL、（498.1±30.5）ng/mL，对照组分别为（411.6±65.8）ng/mL、（319.1±31.5）ng/mL、（526.4±41.3）pg/mL，两组 IGF-1、β-CTX 水平较治疗前明显上升，Svcam-1 水平明显下降，观察组变化幅度明显优于对照组，比较差异有统计学意义（P<0.05）。结论：全髋关节置换术对移位型股骨径骨折，引起的炎性反应较小，能明显降低术后并发症，具有较好的远期疗效。 |
| 关键词: 全髋关节置换术 动力髋螺钉内固定 移位型股骨颈骨折 细胞因子 |
| DOI：10.3969/j.issn.1007-6948.2019.06.027 |
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| 基金项目: |
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| Effect of Different Treatment Methods on Hip Joint Function and Related Cytokines in Displaced Femoral Neck Fracture |
| ZHONG Jie-lin,CAI Ying,JIN Cheng-hao |
| Fourth Orthopaedics Departments, Tianjin Teda Hospital, Tianjin (300475), China |
| Abstract: |
| Objective To investigate the effects of total hip replacement and dynamic hip screw internal fixation on hip function, serum inflammatory factors and biochemical indicators of delayed union of displaced femoral neck fracture. Methods The clinical data of 100 patients with displaced femoral neck fracture treated in our hospital from July 2014 to July 2016 were retrospectively analyzed. Fifty-two patients undergoing total hip arthroplasty were treated as observation group and 48 patients undergoing hip screw internal fixation were treated as control group. The Aubignbey-Postel score and complications of hip joint function improvement before and 12 months after treatment were compared and analyzed between the two groups. Serum inflammatory factors such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), insulin-like growth factor-1 (IGF-1), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (Svcam-1) and type I collagen carboxyl terminal peptide beta special sequence (β-CTX) were measured before and 1 week after operation. Results After 12 months of surgery, the improved hip function Aubigné-Postel score of the observation group was 82.96%, which was significantly higher than that in the control group (62.50%) for the same period, and the difference was statistically significant (P<0.05); Twelve months after the operation, the incidence of complications in the observation group was 1.92% (1 case), significantly lower than that in the control group (29.17%, 14 cases), and the difference was statistically significant (P < 0.05). Before treatment, the levels of IL-6, TNF-α and IL-1β in the observation group were (9.8±1.1) pg/mL, (2.3 0.4) ng/mL and (2.9±0.3) pg/mL respectively, while those in the control group were (9.9±1.2) pg/mL, (2.2±0.4) ng/mL and (2.8±0.3) pg/mL respectively, with no significant difference (P>0.05). One week after treatment, the levels of IL-6, TNF-α and IL-1β in the two groups increased significantly, which were (11.1±1.3) pg/mL, (3.2±0.4) ng/mL, (3.2±0.4) pg/mL in the observation group, and (15.2±1.5) pg/mL, (5.5±0.5) ng/mL and (5.7±0.6) pg/mL in the control group, respectively, and the difference between two groups was statistically significant (P<0.05). Before treatment, the serum insulin-like growth factor-1 (IGF-1), serum soluble vascular cell adhesion molecule-1 (Svcam-1) and type I collagen carboxy-terminal peptide β special sequence (β-CTX) in the observation group were (207.2±44.1) ng/mL, (913.2±55.2) ng/mL, and (458.6±32.5) pg/mL, respectively, and those in the control group were (205.9±43.7) ng/mL, (908.6±54.7) ng/mL, and (461.3±29.7) pg/mL, respectively, with no significant difference (P> 0.05). After 12 weeks of treatment, IGF-1, Svcam-1 and β-CTX in the observation group were (338.1±53.3) ng/mL, (611.3±44.6) ng/mL, and (498.1±30.5) ng/mL, respectively, while those in the control group were (411.6±65.8) ng/mL, (319.1±31.5) ng/mL, and (526.4±41.3) pg/mL, respectively. The levels of IGF-1 and β-CTX in the two groups were significantly higher than those before treatment, and the level of Svcam-1 was significantly lower. The change range of the observation group was significantly better than that of the control group, and the difference was statistically significant (P<0.05). Conclusion Total hip arthroplasty has a small inflammatory response to displaced femoral diameter fractures, which can significantly reduce postoperative complications and has a good long-term effect. |
| Key words: Total hip arthroplasty internal fixation of dynamic hip screws displaced femoral neck fracture cytokines |
