微创防旋股骨近端髓内钉内固定术与人工股骨头置换术治疗高龄股骨转子间骨折近期疗效比较

Comparison of early-stage efficacy between PFNA minimally invasive fixation and hemiarthroplasty for treatment of femoral intertrochanteric fractures in elderly patients

目的探讨微创防旋股骨近端髓内钉(PFNA)内固定术与人工股骨头置换术治疗高龄股骨转子间骨折的近期疗效。方法我院骨科收治的高龄股骨转子间骨折38例,分为微创PFNA内固定术组(21例)与人工股骨头置换术组(17例)进行治疗,比较两组术中出血量、手术时间、切口总长度、下床活动时间、住院总天数、住院总费用、并发症、术后6个月Harris评分。结果两组术中出血量、切口总长度、手术时间、下床时间、住院时间、住院总费用、并发症比较差异均有统计学意义(P<0.05);两组术后6个月Harris评分比较差异无统计学意义(P>0.05)。结论 PFNA与人工股骨头置换治疗高龄股骨转子间骨折近期均能获得一个相对稳定、无疼痛、功能良好的髋关节,微创PFNA内固定术具有操作简便、手术时间短、出血少、切口小、并发症少,费用较少等优点,而人工股骨头置换可以更早下床活动,住院时间更短。

Objective To compare the early-stage curative effect between minimally invasive PFNA fixation and artificial fem- oral head replacement for the treatment of femoral intertrochanteric fractures in elderly patients. Methods Thirty-eight elderly patients with femoral intertrochanteric fracture during the period from June 2011 to February 2013 in our department were selected. They were di- vided into minimally invasive internal fixation with PFNA group （n = 21 ）and artificial femoral head replacement group（ n = 17 ）. Bleed- ing volume, operation time, incision length, time to ambulation, complications, total cost of hospitalization, total Harris score （ 6 months af- ter operation）were compared between the two groups. Results There were significant differences in bleeding volume, the total length of incision, operation time, cost of hospitalization, getting out of bedtime after operation, the total number of days of hospitalization, and the postoperative complications between the two groups （all P 〈 0.05 ）. There was no significant difference in the Harris score of six- mouths after operation between the two groups. Conclusions The early-stage curative effect of the two methods is good. However, the minimally invasive internal fixation with PFNA has advantages of simpler operation, shorter operation time, less bleeding, smaller inci- sion, more reliabte fixation,less complication, and less cost compared to the artificial femorhl head replacement. Conversely, the patients treated with the artificial femoral head replacement operation get out of bed earlier and stay hospital shorter than those treated with the minimally invasive PFNA fixation.