人工股骨头置换术治疗不稳定型老年骨质疏松性股骨粗隆间骨折

Treatment of artificial femoral head replacement for elderly osteoporotic patients with unstable intertrochanteric fractures

目的探讨人工股骨头置换术治疗老年骨质疏松性股骨粗隆间骨折的临床效果。方法回顾性分析2010年7月至2013年9月沈阳医学院中心医院收治的56例老年不稳定型骨质疏松性股骨粗隆间骨折患者的临床资料,其中22例采用人工股骨头置换术治疗（置换组）,34例行股骨近端防旋髓内针（PFNA）内固定（对照组）。记录两组患者手术时间、术中出血量、住院时间、术后负重行走时间和切口愈合时间,观察患者术后并发症发生情况,按Harris髋关节功能评分评估两组术前和术后14 d、3个月患髋关节功能。结果所有患者获得随访,术后随访时间3~24个月（平均12.5个月）。置换组在术后负重时间、并发症发生率方面优于对照组,两组比较,差异有统计学意义（P〈0.05）;两组住院时间和切口愈合时间比较,差异无统计学意义（P〉0.05）。术前和术后14 d、3个月Harris评分比较,差异有统计学意义（P〈0.05）;两组间不同时相点Harris评分及优良率比较,差异无统计学意义（P〉0.05）。置换组患者无假体脱位、松动及关节感染,对照组2例因螺旋刀片选择过长而出现活动性髋外侧疼痛。结论人工股骨头置换可获得与PFNA内固定相似的临床疗效,同时具有术后负重时间短、并发症少等优点,是治疗老年不稳定型骨质疏松性股骨粗隆间骨折的较好选择。

Objcective To observe the clinical effect of artificial femoral head replacement （AFHR） for the treatment of elderly patients with osteoporotic intertrochanteric fractures. Methods Clinical data of 56 elderly osteoporotic patients with unstable intertrochanteric fractures treated in Central Hospital Affiliated to Shenyang Medical College from July 2010 to September 2013 were analyzed retrospectively, in which 22 patients performed AFHR （replacement group）, and 34 patients were treated by proximal femoral nail antir-otation （PFNA） internal fixation （control group）. Operative time, intraoperative estimate blood loss, hospital stay, postoperative weight-loading walk time and incision healing time in 2 groups were recorded, postoperative complications were observed, and hip function at preoperation and 14 d, 3 months after the operation were evaluated according to Harris hip function scoring. Results All patients were followed up with an average of 12.5 months （range, 3-24 months）. Postoperative weight-bearing time as well as incidence of complications in replacement group were better than those in control group, the differences had statistical significance （P 〈0.05）;while as for hospital day and incision healing time, there were no statistical differences between two groups （P〉0.05）. Harris scores at 14 d and 3 months after the surgery improved when compared with preoperative ones （P 〈0.05）; while Harris score, and the good and excellent rate at different time point had no statistical differences between two groups （P 〉0.05）. No prosthesis dislocation, loosening or infection were found in replacement group, and there were 2 cases with lateral hip mobile pain due to too long blade in control group. Conclusion AFHR is one of reliable choices for elderly osteoporotic patients with unstable intertrochanteric fractures due to the advantages of short weight-bearing time, less complications and similar efficacy to PFNA internal fixation.