两种内固定治疗老年骨质疏松性股骨粗隆骨折后对TGF-β2表达的影响及疗效比较

摘要

目的 检测DHS和PFNA治疗老年骨质疏松性股骨粗隆骨折后TGF-β2 (Transforming growth factor-β2,TGF-β2)表达的改变,评价PFNA与DHS对骨折愈合的影响.方法 234例股骨粗隆骨折患者随机分组,分别采用DHS和PFNA固定治疗.采用ELISA法在手术治疗后第1、7、30、60天分别检测TGF-β2的含量;比较手术后3月时的临床疗效.结果 手术治疗第7天后TGF-β2含量较第1天有所上升,而至术后30～60天,TGF-β2含量又逐渐下降.同时间点两组间比较,DHS固定组TGF-β2含量均较PFNA固定组低(P＜0.01).术后3月时,DHS固定组疗效优良率为76.4％,低于PFNA固定组的90.3％(x2=4.226,P=0.036).两组的并发症发生率相当(x2=0.068,P=0.794).结论 PFNA固定治疗股骨粗隆骨折优于DHS固定,TGF-p2表达的差异在其中起到一定的作用.%Objective To detect the TGF-β2 expression change in the patients ofaged osteoporosis femur intertrochanteric fracture after fixed by DHS and PFNA and to evaluate the therapeutic effects of DHS and PFNA on the fracture healing.Methods Randomized grouping design was used in the 234 femur intertrochanteric fracture patients who were performed the fixation by DHS or PFNA.TGF-β2 was tested at 1,7,30and 60 days post-surgery by ELISA method,and the clinical effects were compared at 3 months post-surgery.Results The content of TGF-β2 was higher at 7 days post-surgery than that at 1 day post-surgery,and the content decreased gradually from 30 to 60 days post-surgery.At the same time point,the TGF-β2 content of DHS group was lower than that of PFNA group.At 3 months post-surgery,the excellent and good rate of therapeutic effects in DHS group was 76.4％,lower than 90.3％ in PFNA group,but the rates of complication in both groups were similar.Conclusion The treatment of aged osteoporosis femur intertrochanteric fracture by PFNA fixation could be better than that by DHS fixation,and the expression differences of TGF-β2 could play a certain function.