三种方法治疗高龄股骨粗隆间骨折的前瞻对照研究

Comparison of Traction,External Fixator,and Proximal Femoral Nail Anti-Rotation for Treating Femoral Intertrochanteric Fractures in Elderly

目的:比较应用牵引、外固定支架、股骨近端防旋髓内钉(PFNA)治疗高龄股骨粗隆间骨折的疗效。方法:前瞻性分析120例老年股骨粗隆间骨折患者的临床资料,比较3种方法在住院时间、下地时间、住院费用、愈合时间及髋关节功能的差异,并比较外固定支架组和PFNA组在手术时间、出血量方面的差异。结果:支架组在手术时间、术中出血量较PFNA方面有明显优势(P<0.05);在住院时间:支架组最短(10.3±4.5)d,牵引组最长(30.5±12.3)d,3组比较差异有统计学意义(P<0.05)。下地时间:PFNA最早下地(3.2±1.4)周、支架组其次(3.4±1.3)周,但是两组间比较差异无统计学意义(P>0.05),牵引组最迟下地(6.2±3.7)周,与前两组比较差异有统计学意义(P<0.05)。骨折愈合时间:PFNA组最短(1.3±1.8)月,与支架组比较差异无统计学意义(P>0.05),牵引组最长(2.3±1.2)月,与前两组比较差异有统计学意义(P<0.05)。住院费用:牵引组(1.2±0.4)万元、支架组(1.1±0.6)万元、PFNA(2.4±1.3)万元,前两组间比较差异无统计学意义(P>0.05),而与PFNA组比较差异有统计学意义(P<0.05)。并发症方面:牵引组26例、支架组17例、PFNA组9例。术后髋关节功能优良率:牵引组44.4%;外固定组72.2%;PFAN组82.5%。结论:高龄粗隆间骨折应采用个性化的治疗方法。对于骨质情况较好、骨折稳定,基础疾病少,可优先考虑使用支架外固定;对于不能耐受较长手术和麻醉的患者,支架固定亦是较好的选择;PFNA对于经济条件好、能够耐受手术的各型粗隆间骨折、尤其是伴明显骨质疏松的患者有较强的适应证。牵引治疗只适应于不能耐受手术治疗的患者。

Objective：To compare the curative effects of traction, external fixator, and proximal femoral nail anti-rotation （PFNA） for treating femoral intertrochanteric fractures in elderly. Methods：The clinical data of 120 elderly patients with femoral intertrochanteric fracture was prospectively analyzed. The hospital stay time, weight-bearing time, the cost of hos-pitalization, union time, and hip function was compared in the three groups, and the operation time and amount of intraop-erative bleeding were compared between external and PNFA groups. Results.. The mean operation time and amount of intra-operative bleeding in external group was superiority to PFNA group （P〈0.05）. The hospital stay time was shortest in ex-ternal group （10.3±4.5 d）, and longest in the traction group （30.5±12.3d, P〈0.05）. The weight-bearing time was shortest in PFNA group （3.2±1.4 w）, followed by external group （3.4±1.3 w, P〉0.05）, and longest in the traction group （6.2±3.7w, /2〈0.05）. The fracture healing time was shortest in PFNA group （1.3±1.8m）, which was not dif-ferent with external group （P〉0.05）, and longest in the traction group （2.3±1.2m, P〈0.05）. The cost of hospitaliza-tion was 1.2±0.4 and 1. 1±0.6 ten thousand yuan in the traction group and external group respectively （P〉0.05）, which were significantly lower than PFNA group （2.4±1.3 ten thousand yuan, P〈0.05）. The complication was seen in 26, 17, and 9 cases in traction group, external group, and PFNA group respectively. The excellent rate of postoperative hip function was 44.4%, 72.2%, and 82.5% in traction group, external group, and PFNA group respectively. Conclu-sion：The intertrochanteric fractures in elderly should be treated individually. The external fixation is priority to the patients with good bone condition, stable fracture, and less other diseases, and to the patients who can not tolerate a long surgery and anesthesia; the PFNA is suitable for treating various types of intertrochanteric fractures who can withstand surgery and affordable, especially for osteoporosis patients; the traction is only suitable for the patients who can not tolerate surgery.