人工股骨头置换与PFNA内固定治疗高龄股骨转子间不稳定骨折的疗效分析

Treatment of senile patients with unstable femoral intertrochanteric fracture:comparison between hemiprosthesis arthoplasty and PFNA internal fixation

目的对高龄不稳定性股骨转子间骨折病人进行回顾性分析,比较双极人工股骨头置换和防旋型股骨近端髓内钉(PFNA)固定两种治疗方案的疗效及术后并发症发生率。方法随访病例共65例,男16例,女49例,年龄80～101岁,平均87岁;Evans分型,ⅢA型25例,ⅢB型29例,Ⅳ型11例;A组34例:行双极人工股骨头置换治疗;B组31例:行PFNA内固定治疗。结果随访时间6～23个月,两组的住院时间、助行器辅助下床活动时间、在院并发症发生率、功能评价均无显著性差异(P>0.05);而手术时间、术中失血量有显著性意义(P<0.05)。结论采用双极人工股骨头置换与PFNA内固定治疗高龄股骨转子间不稳定骨折,两组病例卧床时间短、在院并发症发生率低,但PFNA治疗组手术时间更短、术中出血量更少,并且避免了股骨头置换术后关节疼痛、假体松动及翻修等问题。

Objective To compare the results and complications between hemiprosthesis arthroplasty and proximal femoral nail anti-rotation （PFNA） internal fixation in the treatment of unstable femoral intertrochanterie fractures for elderly patients. Methods From January 2008 to May 2009, 65 elderly patients （male 16 and female 49） of unstable intertrochanteric fractures were followed. The average age was 87 years old （range from 80 to 101 years old）. According to the Evans classification of intertrochanteric fractures, there were 25 cases in type m A, 29 cases in II1 B and 11 cases in type IV. 65 patients were treated with hemiprosthesis arthroplasty （A group） AND PFNA internal fixation （B group） in our hospital. Results Sixty-five patients were followed with the periods ranging from 6 to 23 months. There were no significant difference between the two groups （ P 〉0. 05 ） , in duration of hospitalization, ambulation time with walker, complications and function. There was significant difference in blood loss and duration of operation （P 〈0. 05）. Conclusion A and B group are effective to treat unstable femoral intertroehanteric fractures in elderly patients, which reduce the bed time and lower the complications; while treated by PFNA, the patients get less operation time and less intra-operative blood loss, and it also helps avoid the joint pain, prosthesis loosening and other problems after hemiprosthesis arthroplasty.