半髋关节置换与PFN内固定治疗高龄不稳定型股骨粗隆间骨折的疗效比较

Comparison of hemiarthroplasty and PFN fixation for the treatment of unstable intertrochanteric hip fractures in senile patients

[目的]分析比较PFN内固定与半髋关节置换治疗高龄不稳定型股骨粗隆间骨折的疗效,探讨治疗高龄不稳定型股骨粗隆间骨折的合理治疗方法。[方法]回顾性分析2005年4月-2007年4月间接受PFN内固定或半髋关节置换治疗且具有完整资料的82例高龄股骨粗隆间骨折。其中PFN内固定组46例,半髋关节置换组36例;均合并有多系统内科疾病。按改良Evens-Jensen分型,均为不稳定骨折。比较2种治疗方法在切口长度,手术时间、术中出血量,手术输血量、术后卧床时间,内科并发症、内植物并发症、术后1年关节功能状况等方面的指标。[结果]PFN内固定组和半髋关节置换组的平均随访时间分别为16、18个月。PFN内固定治疗组与半髋关节置换组相比较,手术时间、术后卧床时间均较长,手术出血量、输血量较少,切口长度较小(P<0.05),但内科并发症、内植物并发症、髋关节功能恢复等差异不明显(P>0.05)。[结论]半髋关节置换术和PFN内固定术均是治疗高龄患者粗隆间不稳定骨折的有效方法。

[ Objective] To discuss a reasonable treatment for unstable intertrochanteric hip fractures in senile patients by comparing the effects of PFN fixation and hemiarthroplasty. [ Method] Totally 82 intertrochanteric hip fractures in senile patients with complete clinical data were retrospectively analyzed, who were treated with hemiarthroplasty or PFN fixation from April 2005 to April 2007. Forty-six were treated with hemiarthroplasty, 36 were treated with PFN fixation. All of them had multiple medical co-morbidities. According to modified Evens-Jensen classification, all of them belonged to unstable fracture. Comparison was made between the two treated groups in terms of the length of incision, operative time, the blood lost, blood transfusion during or after surgery, time for bed rest postoperatively, postoperative complications and St. Michael hip score one year after surgery. [ Result ] The average duration of follow-up for PFN fixation and hemiarthroplasty were 16 and 18 months respectively. Compared with the group of hemiarthroplasty, the group of PFN fixation experienced longer operation time, longer time for bed rest postoperatively, less blood lost, less blood transfusion during or after surgery, shorter incision length, and the differences between two groups had statistical significance （ P 〈 0.05 ）. Whereas the differences in the postoperative internal medicine complications and the postoperative implant complications, St. Michael hip score one year after surgery between two groups had of no statistical significance （P 〉 0. 05 ）. [ Conclusion] Both of the two methods are reasonable treatment for unstable intertrochanteric hip fractures in senile patients.