两种方法治疗Evans Ic型股骨粗隆间骨折的疗效比较

A Comparison of Two Kinds of Operatiion in Treatment of Elderly Evans Type Ic Intertrochanteric Fractures

目的比较人工股骨头置换术与股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)治疗高龄Evans Ic型股骨粗隆间骨折患者的临床效果。方法 2010年1月至2012年7月间,我院共收治45例高龄Evans Ic型股骨粗隆间骨折患者,按照治疗方法分为PFNA组与人工股骨头置换手术组,其中PFNA组21例,人工股骨头置换组24例。术后将两组患者的手术时间、术中出血量、术后负重时间、术后并发症发生率以及术后3个月、12个月患髋Harris评分进行对比分析。结果有43例患者得到随访,2例失访,平均随访时间16.1个月。PFNA内固定失败患者3例,后改用人工股骨头置换术治疗。在手术时间、术中出血量方面,PFNA组低于关节置换组,差异有统计学意义(P<0.05);术后早期下床时间及术后3个月髋关节Harris评分方面人工股骨头置换组优于PFNA组,差异有统计学意义(P<0.05);两组间术后1年髋关节Harris评分以及术后并发症发生率比较,差异无统计学意义(P>0.05)。结论对于高龄Evans Ic型股骨粗隆间骨折应首选PFNA固定,但对于严重骨质疏松或内固定失败患者应采用人工股骨头置换术。

Objective To compare treatment effects between artificial femoral head replacement and proximal femoral nail anti-rotation（PFNA） in the elderly Evans type Ic femoral intertrochanteric fractures. Methods From January 2010 to July 2012 ,there were 48 elderly patients who had suffered from Evans type Ic femoral intertrochanteric fractures,which were retro- spectively analyzed based on operative management. PFNA for 21 cases and artificial femoral head replacement for 24 cases. The clinical results of the 2 groups were documented and compared in the followed aspects ： operation time, blood loss during operation,load bearing time,incidence rates of complications and the Harris hip score of 3 and 12 months after operation. Re- suits There were 43 patients got follow-up,2 cases were lost,with average follow-up time was 16.1 months. There were 3 pa- tients who failed with PFNA internal fixation were treated with artificial femoral head replacement. Follow-ups showed that PF- NA group was superior to artificial femoral head replacement group in the operation duration and the blood loss during operation （P 〈0.05） ,and inferior to artificial femoral head replacement group in the load bearing time and the Harris hip score at the time 3 months after operation （ P 〈 0.05 ）, There were no significant difference in the incidence rates of complications and the Harris hip score at the time 12 months between two groups （ P 〉 0. 05 ）. Conclusion PFNA can be preferred to apply in the elderly Evans Ic femoral intertrochanteric fractures, but to severe osteoporosis or internal fixation failure, the artificial femoral head replacement is better.