人工股骨头置换与股骨近端髓内钉治疗高龄患者股骨粗隆间骨折的对比研究

Comparison study of hip hemiarthroplasty and proximal femoral nail for the treatment of intertrochanteric fracture in elderly patients

目的对比分析人工股骨头置换和股骨近端髓内钉（PFN）内固定治疗高龄不稳定型股骨粗隆间骨折的临床疗效，评价两种手术治疗方案的优劣。方法选取2002-5-2008—6我院收治的高龄不稳定型股骨粗隆间骨折患者78例，其中行人工股骨头置换42例，PEN内固定36例。对两组患者的术前合并症、手术时间、术中失血量、输血例数、输血量、负重时间、住院时间、术后并发症等临床指标以及末次随访时患侧髋关节功能Harris评分进行统计学分析。结果随访6～48个月，平均26．5个月。两组患者术前合并症、骨折类型及骨质疏松程度即Singh指数均无明显统计学差异（P〉0．05），股骨头置换组在手术时间、住院时间、失血量及输血例数上明显多于PFN组（P〈0．05）。两者在负重时间上差异无统计学意义。股骨头置换组术后平均Harris评分为（85．2±12．8）分，与PFN组比较差异无统计学意义。结论PEN内固定与人工股骨头置换术治疗高龄不稳定股骨粗隆间骨折在功能恢复上基本相同，但前者较人工股骨头置换术具有手术及住院时间短、失血量少等优点。

Objective To comparatively analyze the clinical effects of hemiarthroplasty and proximal femoral nail internal fixation for treatment of unstable intertrochanteric fractures in aged patients and evaluate the merits and defects of the two methods. Methods From May 2002 to June 2008, 78 elderly patients with unstable intertrochanteric fractures were choosed at random. 42 cases were treated with hemiarthroplasty and 36 cases were treated with proximal femoral nail internal fixation. The clinical data of the two groups such as the preoperative coexisting diseases, duration of operation, intraoperative blood loss, units of blood transfused, time of weightbearing, duration of hospitalization, postoperative complications and the last followed-up Harris scores of affected hip joint were collected for statistical analysis. Results The average followed-up time was 26.5 months ranged from 6 months to 48 months. In comparison of the preoperative coexisting diseases, fracture classification and condition of osteoporosis （Singh index）, there was no significant difference between the two groups （P 〉 0.05 ）. While in comparison of the duration of operation, duration of hospitalization, blood loss and units of blood transfused, the differences were significant （P〈 0.05）. Weight-bearing time of two groups was similar. The average postoperative Harris scores of hemiarthroplasty group was 83 ± 12.8, the difference was significant in contrast of PFN group. Conclusion Proximal femoral nail and hemiarthroplasty are effective and satisfactory methods to treat unstable intertrochanteric fracture in aged patients and have the same functional recovery outcomes, but proximal femoral nail internal fixation has the advantages of shorter operation and hospitalization time and less blood loss.