半髋关节置换与PFNA治疗高龄不稳定型股骨粗隆间骨折的临床疗效比较

Comparison of hemiarthroplasty and proximal femoral nail anti-rotation for the treatment of unstable intertrochanteric fracture in senile patients

目的对比两种术式治疗高龄不稳定型股骨粗隆间骨折的临床疗效。方法分别应用半髋置换与防旋型股骨近端髓内钉(PFNA)治疗高龄不稳定型股骨粗隆间骨折患者72例及78例,比较两种术式的疗效。结果 PFNA组手术时间、出血量、引流量及早期并发症发生率均优于半髋组,差异有统计学意义(P<0.05或P<0.01),半髋组患肢负重时间、髋关节功能优良率及晚期并发症发生率均优于PFNA组,差异有统计学意义(P<0.05或P<0.01)。结论半髋置换适用于骨质疏松严重、内科疾病少、身体情况好的患者,但早期并发症较多;对于身体素质差、内科疾病多的患者,可选择PFNA治疗,但晚期并发症多,应注重抗骨质疏松治疗及适当延长患肢负重时间。

Objective To compare the clinical efficacy of two operation methods for unstable intertrochanteric fracture. Methods All of 72 cases were treated with hemiarthroplasty while 78 cases were treated with proximal femoral nail anti- rotation（PFNA）, all of them belonged to unstable intertrochanteric fractures. Comparison was made between the two treated groups in clinical efficacy. Results Operative time,blood lost,drainage volume after operation,early complication incidence in PFNA group were better than the group of hemiarthroplasty,the hemiarthroplasty group excelled the PFNA group in weight-bearing time,late complication ,excellent and good rate of hip function ,there were statistical differences between two groups （P 〈 0.05 ~ P 〈 0.01 ）. Conclusion Hemiarthroplasty was suitable for patients with severe osteoporosis,less basic diseases, or the body in good condition because of early complications ; the patients with poor body condition, or more basic diseases could choose PFNA treatment,importance should be attached to treatment of osteoporosis and appropriate extension of limb weight-bearing time because of late complications.