防旋型股骨近端髓内钉固定与人工股骨头置换对高龄不稳定股骨粗隆间骨折的疗效比较

Comparison Between Proximal Femoral Nail Antirotation and Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Femoral Fracture in the Elderly

目的:评价防旋型股骨近端髓内钉(PFN-A)与人工股骨头置换治疗高龄不稳定股骨粗隆间骨折的疗效。方法:将2009年2月-2012年9月45例高龄不稳定股骨粗隆间骨折病人,分为PFN-A固定组(A组)和人工股骨头置换组(B组),对两组患者的手术时间、出血量、术后下地负重行走时间,髋关节功能及并发症等指标进行分析。结果:45例高龄不稳定股骨粗隆间骨折的两组病人经手术治疗均获得成功;在手术时间、出血量方面的比较中,无明显统计学意义(P>0.05),在术后10.4-15.5个月随访中,虽然最终两组手术患者能获得同样的功能评定,但是在术后6周-6月的早期负重活动,功能评分及术后并发症方面比较中,人工股骨头置换术组明显优于PFN-A固定组(P<0.05)。结论:人工股骨头置换在高龄不稳定股骨粗隆间骨折手术中较PFN-A更有优势,能明显改善高龄患者的生活质量,减少并发症及卧床时间;值得临床推广。

Objective： To evaluate and compare the therapeutic efficacy of proximal femoral nail antirota- tion （PFN-A） fixation and hemiarthroplasty in the treatment of elderly patients with unstable intertrochanteric fracture. Methods. Between Feb, 2009 and Sept, 2012, 45 patients were divided into PFN-A fixation group （group A） and hemiarthroplasty group （group B）. Surgical time, blood loss, weight-bearing ambulation after surgery, hip function and complications were observed. Results. Surgical treatment was successful in all the 45 cases of unstable intertrochanteric fractures elderly patients. There was no significant difference in surgical time and blood loss be- tween the two groups （P^0. 05）. The follow-up time was between 10. 4 months to 15. 5 months, although both groups acquired the same hip function outcomes at last, less complications, better hip function scores, and shorter time before weight-bearing ambulation were found in group B during 6 weeks to 6 months＇ follow-up after operation. Conclusion： Hemiarthroplasty is better than PFN-A for its advantages of less complications and early weight-bearing ambulation in treating elderly patients with unstable intertrochanteric fractures.