股骨近端抗旋髓内钉置入和骨水泥型人工股骨双动头置换治疗老年转子间骨折

Proximal femoral nail anti-rotation versus artificial femoral head replacement for femoral intertrochanteric fracture in the elderly

背景:针对高龄股骨转子间骨折的治疗方法选择尚存在争议。目的:比较股骨近端抗旋髓内钉置入和人工股骨头置换治疗高龄股骨转子间骨折的疗效。方法:2007-10/2009-06入选老年转子间骨折患者79例,股骨近端抗旋髓内钉置入内固定34例,年龄65～81岁;人工股骨头置换45例,年龄67～94岁。对住院时间,手术时间,出血量,固定/置换后并发症和髋关节功能进行评价。结果与结论:79例固定/置换后随访6～24个月,平均(17.5±4.9)个月。两组在住院时间,固定/置换后并发症和关节功能Harris评分方面差异无显著性意义(P>0.05),在手术时间和术中出血量方面股骨近端抗旋髓内钉置入较股骨头置换有较大优势(P手术时间<0.001,P术中出血量<0.0001),但股骨近端抗旋髓内钉组下地时间较股骨头置换组晚(P<0.0001)。结果表明股骨近端抗旋髓内钉置入和人工股骨头置换是治疗高龄股骨转子间骨折的有效方法,与人工股骨头置换比较,股骨近端抗旋髓内钉置入固定具有手术时间短,术中出血少的优点,但卧床时间较长。应严格掌握病例选择标准,选用合适的技术治疗。

BACKGROUND：It remains controversial on treatments for elderly femoral intertrochanteric fracture in elderly.OBJECTIVE：To compare the curative effects between proximal femoral nail anti-rotation （PFNA） and artificial femoral head replacement in treatment of femoral intertrochanteric fracture in the elderly.METHODS：From October 2007 to June 2009,79 cases of femoral intertrochanteric fracture in elderly patients were treated by PFNA （n=34 cases,aged 65-81 years） and femoral head replacement （n=45,aged 67-94 years）.The difference of length of stay,operation time,intraoperative bleeding,postoperative complications and the function changes of hip joint was analyzed.RESULTS AND CONCLUSION：All patients were followed up for 6 to 24 months,with an average of 17.5±4.9 months.There were no statistical differences between two groups in terms of hospital stay,postoperative complications and function change of hip （Harris scores;P0.05）.PFNA exhibited advantages in operation time （P0.001）,intraoperative bleeding （P0.000 1） compared with artificial femoral head replacement,but bedridden time was longer than artificial femoral head replacement group （P0.0001）.Both the PFNA method and the artificial femoral head replacement have good clinic curative effects in treatment of femoral intertrochanteric fracture in elderly patients.PFNA has advantages of short operation time and less bleeding but long bedridden time.The surgery should be selected according to the actual situations of patients.