股骨近端螺旋刀片抗旋髓内钉内固定和人工股骨头置换治疗老年转子间骨折的临床疗效对比

Clinical Efficacy Comparison of Proximal Femoral NailAnti-rotation and Artificial Femoral Head Replacement in the Treatment ofAged Patients with Intertrochanteric Fractures

目的:比较和分析股骨近端螺旋刀片抗旋髓内钉(PFNA)内固定和人工股骨头置换术治疗老年转子间骨折的临床效果。方法:对我院2008年1月至2012年1月收治的256例因骨股骨转子间骨折而住院老年患者的临床资料进行回顾性分析,其中,89例患者采用了人工股骨头置换术进行治疗(A组),167例患者采用了PFNA内固定术(B组),观察两组患者的手术时间、术中出血量、住院时间、并发症情况以及术后1-9个月的Harris评分变化情况。结果:PFNA组患者的手术时间和术中出血量均低于股骨头置换组,且差异均有统计学意义(P<0.05);PFNA组患者的术后住院天数较股骨头置换组略长(P>0.05)。PFNA组患者术后下地承重所需时间明显长于关节置换术组,且差异有统计学意义(P<0.05);两组并发症的发生率差异有统计学意义(P<0.05),但两组切口感染的发生率无统计学差异(P>0.05)。两组患者的Harris评分相当,差异无统计学意义(P>0.05)。结论:PFNA内固定术和关节置换术治疗老年性转子间骨折的临床效果基本一致,且均有着各自的优点和不足,临床上应根据老年患者的自身具体情况,制定个体化的手术方式,以促进老年患者的预后和恢复。

Objective：To compare the clinical effect of proximal femoral nail anti-rotation（PFNA） and artificial femoral head replacement in the treatment of aged patients with intertrochanteric fractures.Methods：Clinical data 256 patients with intertrochanteric femur fractures were retrospectively analyzed.89 patients were treated with artificial femoral head replacement（group A）,167 patients with a PFNA fixation（group B）.Surgical time,blood loss,hospital stay,complications,and postoperative Harris score for two groups were compared.Results：Surgical time and blood loss volume in the PFNA group were lower than femoral head replacement group（P0.05）;postoperative hospital stay time in PFNA group was slightly longer than the femoral head replacement group（P0.05）.Postoperative ambulation the bearing for PFNA group of patients significantly longer than the time required for the arthroplasty group（P0.05）;difference of postoperative complications incidence was statistically significant（P0.05）.Difference of Harris scores for the two groups was not statistically significant（P0.05）.Conclusion：Clinical effect of PFNA internal fixation and arthroplasty for senile intertrochanteric fracture is basically the same,and both have their own advantages and disadvantages.It is necessary to develop individualized surgical approach to promote the prognosis and recovery for elderly patients.