David Gómez-Garrido, Michele Bisaccia, Umberto Ripani, Cioancă Florin, Andrea Schiavone, Alfonso Ciotta, Cristina Ibañéz-Vicente, Maria Medina-Lorca, Antonio Herrera-Molepecers Juan, Giuseppe Rollo, Luigi Meccariello
Orthopedics and Traumatology Unit, Quironsalud Toledo Hospital, Toledo, Spain.
Orthopedics and Traumatology Unit, Department of Surgical and Biomedical Science, S.M. Misericordia Hospital, University of Perugia, Sant'Andrea delle Fratte, Perugia, Italy.
Rom J Anaesth Intensive Care. 2020 Dec;27(2):17-26. doi: 10.2478/rjaic-2020-0016. Epub 2020 Dec 31.
Trochanteric fractures are a major trauma in the elderly population and represent a significant part of public health spending. Various fixation devices are used as treatment for these fractures. This study aimed to evaluate three surgical methods in the treatment of pertrochanteric femoral fractures.
From January 1, 2013, to December 31, 2014, 86 patients were divided into 3 groups. Fifteen patients were treated with osteosynthesis by reamed intramedullary nailing (RIMN), 15 patients were treated with unreamed intramedullary nailing (UIMN), and 13 patients were treated with dynamic hip screw (DHS) plate osteosynthesis. All patients were >75 years of age. They were evaluated with a clinical radiological follow-up and laboratory examination (LDH, CPK, IL-1-B, IL-8, TNF-α, alpha-1-acid glycoprotein, D-dimer, fibrinogen, ESR, CRP, and procalcitonin).
IL-8, TNF-α, fibrinogen, D-dimer and alpha-1-acid glycoprotein levels were higher in the DHS group compared with the other two groups at 1 month after surgery (P<0.05). LDH, IL-1β, and IL-6 levels were higher in the DHS group compared with the other two groups at 3 months after surgery (P<0.05). From 3 to 6 months after surgery, the TNF-α level was high in the DHS and RIMN groups (P<0.05). Infection markers did not demonstrate a difference among the 3 groups. Twelve patients died during the 12-month follow-up. Regardless of the method used, morbidity and mortality are linked to enticement and comorbidities rather than surgery within 48 hours after the trauma.
From our study, we can affirm that the values of cytokines and interleukins observed remain high during the 12-month follow up, regardless of whatever fixation devices or surgery type was performed within 48 hours of injury. Inflammatory markers are higher in patients in the DHS group. This can probably be explained by the fact that DHS technique is performed by open surgery, and this can create a higher inflammation of soft tissue. Mortality is reduced in the first 30 days after surgery if patients are mobilized early. Therefore, mortality in our study population of patients aged >75 years is linked more to the chronic inflammatory state and comorbidities, rather than fixation device or surgical type used.However, future studies are needed to answer further questions that go beyond the scope of our study.
转子间骨折是老年人群中的一种主要创伤，占公共卫生支出的很大一部分。各种固定装置被用于治疗这些骨折。本研究旨在评估三种手术方法治疗股骨转子周围骨折的效果。
2013年1月1日至2014年12月31日，86例患者被分为3组。15例患者采用扩髓髓内钉固定术（RIMN）治疗，15例患者采用非扩髓髓内钉固定术（UIMN）治疗，13例患者采用动力髋螺钉（DHS）钢板固定术治疗。所有患者年龄均大于75岁。通过临床影像学随访和实验室检查（乳酸脱氢酶、肌酸磷酸激酶、白细胞介素-1-β、白细胞介素-8、肿瘤坏死因子-α、α-1-酸性糖蛋白、D-二聚体、纤维蛋白原、血沉、C反应蛋白和降钙素原）对患者进行评估。
术后1个月时，DHS组的白细胞介素-8、肿瘤坏死因子-α、纤维蛋白原、D-二聚体和α-1-酸性糖蛋白水平高于其他两组（P<0.05）。术后3个月时，DHS组的乳酸脱氢酶、白细胞介素-1β和白细胞介素-6水平高于其他两组（P<0.05）。术后3至6个月，DHS组和RIMN组的肿瘤坏死因子-α水平较高（P<0.05）。感染指标在3组之间未显示出差异。12例患者在12个月的随访期间死亡。无论采用何种方法，发病率和死亡率与诱因和合并症有关，而不是与创伤后48小时内的手术有关。
从我们的研究中可以肯定，无论在受伤后48小时内采用何种固定装置或手术类型，在12个月的随访期间观察到的细胞因子和白细胞介素值仍然很高。DHS组患者的炎症标志物较高。这可能是因为DHS技术是通过开放手术进行的，这会导致软组织炎症反应更高。如果患者早期活动，术后前30天的死亡率会降低。因此，我们研究中年龄大于75岁的患者群体的死亡率更多地与慢性炎症状态和合并症有关，而不是与所使用的固定装置或手术类型有关。然而，需要进一步的研究来回答超出我们研究范围的更多问题。
