两种方法治疗高龄股骨粗隆间骨折疗效比较

Comparsion of two surgical treatments for intertrochanteric fracture in the elderly

[目的]比较人工股骨头置换与股骨近端髓内针(PFNA)治疗高龄患者不稳定股骨粗隆间骨折的临床疗效。[方法]54例高龄不稳定股骨粗隆间骨折患者随机分为人工股骨头置换术组(A组)及PFNA固定术组(B组)。对两组患者的出血量、手术时间、负重行走时间、髋关节功能及术后并发症等指标进行统计学分析。[结果]两组的手术出血量及手术时间差异无统计学意义(P>0.05)。但在术后早期负重活动、Harris评分及术后并发症方面,人工股骨头置换组优于PFNA固定组,差异有统计学意义(P<0.05)。[结论]相对于PFNA固定组,人工股骨头置换治疗高龄不稳定股骨粗隆间骨折具有卧床时间短,术后并发症少,早负重及关节功能恢复快等优点。

[Objective]To compare the clinical outcomes of unstable intertrochanteric fracture treated with long-stem femoral head replacement and proximal femoral nail antirotation（PFNA） in the elderly.[Method]From August 2010 to August2013,54 consecutive patients with unstable intertrochanteric fracture were randomly given hemiarthroplasty（group A） or PFNA fixation（group B）,with 27 patients in each group.Blood loss in operation,length of operation,starting time of ambulation,hip function and complications were evaluated and compared between the two groups.[Result]Followed-up period ranged from 12 months to 24 months with an average of 18 months.There was no significant difference in blood loss and length of surgery（P〉0.05）.However,lower risk of complications,better hip function scores and shorter time to ambulation were found in the group A after operation（P〈0.05）.[Conclusion]Compared with the PFNA fixation group,long-stem femoral head replacement for treatment of intertrochanteric fracture in the elderly has many advantages,such as shorter bed rest,lower risk of complications,shorter time to get back ambulation and faster recovery of hip function.