不同方法治疗老年股骨转子间不稳定骨折疗效对比

Comparison of Clinical Efficacy of Different Methods in the Treatment of Unstable Femoral Intertrochanteric Fractures in the Elderly

目的对比分析生物型加长柄关节置换与股骨近端防旋髓内钉内固定治疗老年股骨转子间不稳定骨折的临床效果。方法选取2019年6月至2021年6月安阳市第三人民医院收治的104例老年股骨转子间不稳定骨折患者作为研究对象,根据不同手术治疗方式将其分为置换组(52例)和固定组(52例),置换组患者采用生物型加长柄关节置换术治疗,固定组患者采用股骨近端防旋髓内钉内固定术治疗,对比观察两组患者围术期相关指标、髋关节恢复情况、生活质量及术后不良事件发生情况。结果置换组患者术中出血量明显多于固定组、手术时间明显长于固定组(t=5545、5150,P均<0001),而首次下床活动时间及住院时间与固定组无明显差异(t=1933、1619,P=0056、0109)。术后12个月,置换组患者髋关节恢复优良率为8077%,明显高于固定组患者的髋关节恢复优良率6154%(χ^(2)=4685,P=0030);置换组患者健康调查量表36(SF-36)中的躯体功能、躯体疼痛、总体健康、生理功能评分均明显高于固定组(t=3062、2868、3028、3440,P=0003、0005、0003、0001)。置换组患者术后不良事件发生率为577%,明显低于固定组患者的术后不良事件发生率2115%(χ^(2)=5283,P=0022)。结论与股骨近端防旋髓内钉内固定相比,生物型加长柄关节置换虽会增加老年股骨转子间不稳定骨折患者术中出血量,延长手术时间,但能够提高患者髋关节功能及生活质量,降低不良事件发生风险,临床效果更佳。

Objective To compare the clinical efficacy of cementless long-stem hip joint replacement and proximal femoral nail antirotation internal fixation in the treatment of unstable femoral intertrochanteric fractures in the elderly.Methods 104 elderly patients with unstable femoral intertrochanteric fractures admitted to Anyang Third People’s Hospital from June 2019 to June 2021 were enrolled as the research subjects,and divided into replacement group(n=52)and fixation group(n=52)based on the different treatments they received.Patients in the replacement group were treated with cementless long-stem hip joint replacement,whereas patients in the fixation group were treated with proximal femoral nail antirotation internal fixation.The perioperative related indicators,recovery condition of hip joint,quality of life and occurrence of adverse reactions after surgery were compared between the two groups.Results The intraoperative blood loss of patients in the replacement group was significantly more than that in the fixation group,and the operation duration was significantly longer in the replacement group(t=5545 and 5150,both P<0001),while there were no significant differ-ences between the two groups in terms of the first off-bed ambulation time and the length of stay(t=1933 and 1619,P=0056 and 0109).At 12 months after surgery,the good and excellent rate of hip function recovery was 8077%in the replacement group,which was significantly higher than the corresponding 6154%in the fixation group(χ^(2)=4685,P=0030),the scores of the patients evaluated using the 36-item short form health survey(SF-36)including physical functio-ning,bodily pain,general health,and physiological function were significantly higher in the replacement group compared with the fixation group(t=3062,2868,3028 and 3440,P=0003,0005,0003 and 0001),and the incidence of postoperative adverse reactions of patients was 577%in the replacement group,being much lower than 2115%in the fixation group(χ^(2)=5283,P=0022).Conclusion Compared with proximal femoral nail antirotation internal fixation,cementless long-stem hip joint replacement,in the treatment of elderly unstable femoral intertrochanteric fractures,is superior in ameliorating hip joint function and patients’quality of life,and decreasing the occurrence risk of postoperative adverse reactions,though might lead to more intraoperative blood loss and longer operation time,achieving better clinical efficacy.