高龄股骨粗隆间骨折股骨近端髓内钉内固定和双极人工股骨头置换治疗的比较

Cemented Bipolar Femoral Component Arthroplasty Compared with Intramedullary Fixation for Treatment of Unstable Femoral Intertrochanteric Fractures

目的前瞻性比较股骨近端髓内钉内固定(PFN组)和骨水泥型双极人工股骨头置换(半髋置换组)治疗高龄不稳定股骨粗隆间骨折的疗效。方法68例不稳定股骨粗隆间骨折(男36例,女32例;平均年龄78岁)分别接受PFN内固定和骨水泥型双极人工股骨头置换。记录术中和术后与手术或内植物有关的并发症、失血量、输血例数、输血量、手术时间及每个患者的住院时间。并在最后一次随访时进行Harris评分。结果两组间在年龄、性别、及骨质疏松程度上即Singh指数无明显统计学差异。半髋置换组在手术时间、失血量及输血人数上明显多于PFN组(P<0·01)。二者在负重时间上差异不明显。半髋置换组术后平均Harris评分为82分,和PFN组比较无统计学意义。半髋置换组中有2例在术后30d内发生脑血管意外死亡,1例发生了脑梗死,无脱位、假体松动、感染等发生。另有3例3年内死于与髋部置换无关的疾病。PFN组中,术后30d内无死亡发生,有2例3年内死亡。浅部组织感染1例;股骨颈螺钉穿出1例,无骨折不愈合及深静脉血栓形成。结论PFN内固定和骨水泥型双极人工股骨头置换治疗高龄不稳定股骨粗隆间骨折在功能恢复上基本相同,但后者在失血量及手术时间上高于PFN内固定。

Objective To compare the results of cemented hemiarthroplasty and a proximal femoral nail for treatment of unstable osteoporotic intertrochanteric fractures in elderly patients. Methods Sixty- eight elderly patients with an AO/OTA type 3.1 - A2 intertrochanteric fracture of the femur were classified into two treatment groups and were followed for a minimum of two years. Thirty - four patients in group Ⅰ were treated with a cemented bipolar femoral component arthroplasty, while 34 patients in group Ⅱ were treated with a proximal femoral nail. The two treatment groups were comparable with regard to demographic and injury variables. Results There were no significant differences between the groups in terms of functional outcomes, time to weight - bearing, or general complications. Patients treated with a proximal femoral nail had a shorter operative time, less blood loss, fewer units of blood transfused, a lower mortality rate, and shorter hospital stay compared with those treated with the cemented hemiarthroplasty. Conclusion In elderly patients with an unstable osteoporotic femoral intertrochanteric fracture, a proximal femoral nail provides superior clinical outcomes but no advantage with regard to functional outcomes when compared with a cemented hemiarthroplasty.