PFNA内固定与关节置换治疗高龄骨质疏松患者股骨粗隆间骨折的疗效评价

A comparison of treatment effect of two operative methods for elderly osteoporotic intertrochanteric fractures

目的比较老年股骨粗隆间骨折人工关节置换(HA)与股骨近端防旋髓内钉(PFNA)内固定两种手术方法的临床疗效。方法对2002年1月～2008年1月收治的66例分别接受了PFNA和HA手术治疗的老年股骨粗隆间骨折患者进行回顾性研究,平均随访2年。对住院时间、手术时间、术中出血量、术后引流量、患髋功能及并发症等作比较。结果两组患者住院期间均无死亡病例。HA组住院时间、手术时间均短于PFNA组(P<0.05),而出血量和术后引流量HA组均多于PFNA组(P<0.05)。HA组的术后负重时间、术后功能恢复时间明显早于PFNA组(P<0.05)。PFNA组并发术后股骨干骨折1例,无伤肢短缩等并发症;HA组全部一期愈合,无并发症。术后一个月Harris评分比较,HA组优于PFNA组。结论两种手术治疗方式均有一定优势,各种固定各有其自身特点,PFNA适用于骨质疏松的不稳定型骨折和合并症较多患者,但人工关节置换具有手术时间短、可早期下床活动等优点,更适用于高龄股骨粗隆间骨折的治疗。

Objective To compare treatment effect of two operative methods of hip arthroplasty （ HA ） and proximal femoral nail anti-rotation（PFNA） in the elderly femoral intertrochanteric fractures. Methods 66 cases of elderly intertrochanteric fractures which were treated from January 2001 to January 2008 with HA and PFNA were retrospectively analyzed. They were followed up after operation in average 2 years. Length of stay, operation duration, blood loss during operation, drainage volume of blood, function of effected hip and complications were compared. Results There were no died cases in two groups. The result shows that HA group is shorter than PFNA group in length of stay and operation duration （ P 〈 0. 05 ） , HA group is more than PFNA group in blood loss during operation and drainage volume of blood （P 〈 0. 05）. HA group is earlier both in time of bear weight after operation and in time of function recovery of effected hip than PFNA group （P 〈 0. 05） , In Harris hip score, HA group is better than PFNA group （ P 〈 0.05 ）. There was one femoral shaft fracture occurred after, operation in PFNA group. In HA group, there is no complication,and all incisions healed by first intention. Conclusion Each method of operation has its own benefit. PFNA is ideal method of operation for the patients that have osteoporosis unstable intertrachanterie fractures and many other diseases. But HA has many advantages,such as short operation duration, early to bear weight etc, it is espeeially suitable for elderly patient with femoral intertrachanteric fracture.