股骨近端螺旋刀片抗旋髓内钉内固定和人工股骨头置换治疗高龄患者转子间骨折的疗效分析

Analysis of therapeutic efficacies on proximal femoral nail anti-rotation and artificial femoral head replacement in the treatment of aged patients with intertrochanteric fractures of femur

目的回顾性分析运用股骨近端螺旋刀片抗旋髓内钉(PFNA)内固定和人工股骨头置换治疗转子间骨折的高龄患者,确定两手术的各自适应证。方法收集我院2005～2010年转子间骨折的高龄(≥75岁)患者,股骨头置换84例,PFNA内固定162例,从手术时间、术中出血量、下地承重所需时间、髋关节功能及术后6个月内并发症(褥疮、肺炎、泌尿系感染、再发骨折)的发生情况进行综合分析,确定这两种手术各自的适应证。结果临床资料比较结果:两组患者手术时间、术中出血量有统计学差异(P<0.05),住院天数统计结果显示,两组差异无统计学意义(P>0.05)。随访比较结果:患者开始下地承重的时间有统计学意义(P<0.05),在术后并发症、切口感染及再发骨折方面差异无统计学意义(P>0.05),而在褥疮、肺炎及泌尿系感染方面具有统计学差异(P<0.05)。两组患者髋HARRIS功能评分统计分析结果显示,髋关节在早、中、晚各期的功能差异均无统计学意义(P>0.05)。结论 PFNA内固定治疗在减少手术时间及术中出血量方面有优势,而在早期功能锻炼及减少术后并发症方面稍逊于人工股骨头置换。而远期髋关节功能无显著差异。

Objective Through the analysis by using of PFNA and artificial femoral head replacement in the treatment of aged patients group with intertrochanteric fractures of femur, make sure the indictation of each group after operation. Methods From 2005 to 2010,162 aged patients（ 〉175 years old） with intertrochanteric fractures of femur received fixation of PFNA and another 84 were treated with artificial femoral head replacement, each indictation of two treatments were certained by analyzing the operating time,intraoperative blood loss, the function of the operated hip joint and the happen of finai piacement syndrome （bedsore, pneumonia, urinary infection and refracture ）. Results Clinical data comparative result： The difference between the two group had statistical significance significance （ P 〈 0. 05 ） in operating time, intraoperative blood loss while had no statistical significance （ P 〉 O. 05 ） in days being hospitalized. Comparative result b~~ following visit：It had statistical significance （P 〈0.05）in time when patients begin to stand bearing, had no statistical significance （P 〉 O. 05 ）in the happen of final placement syndrome, incision infection and refracture while had statistical significance （ P 〈 O. 05 ） in bedsore, pneumonia and urinary infection. Analytical result through statistical data of patients HARRIS function ： The difference between the two group had no statistical significance （ P 〉0. 05 ） in HARRIS function during early stage, metaphase and later period. Conclusions PFNA has the advantages in reducing the operating time,intraoperative blood loss;but is not as good as artificial femoral head replacement in decreasing the happen of finai piacement syndrome.