两种方法治疗老年不稳定性股骨转子间骨折的临床对照研究

Clinical controlled study on the treatment of senile unstable intertrochanteric fractures of femur with two methods

目的探讨PFNA与PFLAP治疗老年不稳定性股骨转子间骨折的临床疗效,寻找更有效的方法治疗老年不稳定性股骨转子间骨折。方法选择不稳定性老年转子间骨折患者98例,按照数字表法将患者随机分为PFNA组和PFLAP组,各49例。PFNA组采用PFNA手术治疗,PFLAP组采用PFLAP手术治疗,观察两组患者术中情况(手术切口大小、出血量、手术时间)、术后恢复情况(开始负重时间、骨折愈合时间、住院天数及1年后髋关节功能评分)及并发症情况。结果所有患者平均随访23.5个月。PFNA组患者手术切口长度明显比PFLAP组短(P<0.05);手术时间、住院天数、术后开始负重时间较PFLAP组明显缩短(P<0.05);术中出血量较PFLAP组明显减少(P<0.05);两组骨折愈合时间、髋关节功能评分无明显差异(P>0.05)。PFNA组并发症发生率明显低于PFLAP组(P<0.05)。结论 PFNA具有手术切口小、手术时间短、出血量少、对机体内环境干扰少,对手术耐受性较差的老年患者尤为适用,同时因其固定牢靠,可使患者尽早进行功能恢复锻炼,减少并发症,是治疗老年不稳定性股骨转子间骨折的有效方法。

Objective To explore the clinical efficacy of PENA and PELAP in the treatment of senile unstable intertrochanteric fractures of femur and look for more effective therapy for the treatment of the disease mentioned above. Methods 98 elderly patients with unstable intertrochanteric fractures were chosen and randomly divided into PFNA group and PFLAP group according to number table, and there were 49 cases in each group. Patients in the PFNA group were treated with PFNA operation, and patients in the PFLAP group were treated with PFLAP operation. The intra-operative conditions（surgical incision size, amount of bleeding, operation time）, the postoperative recovery condition（the time of weight loading, the healing time of fracture, hospital stays and Harris hip scores one year after operation） and the complications of patients in the two groups were observed. Results All patients were followed up for average 23.5 months. The surgical incision lengths of patients in the PFNA group were obviously shorter than that in the PFLAP group（P〈0.05）. The operation time, hospital stays and the time of weight loading after operation of patients in the PFNA group were significantly shorter than that in the PFLAP group（P〈0.05）. The intra-operative amount of bleeding in the PFNA group significantly decreased compared that in the PFLAP group（P〈0.05）. The healing time of fracture and Harris hip scores between the two groups had no significant difference（P〈0.05）. The complication rate of the PFNA group was obviously lower than that of the PFLAP group（P〈0.05）. Conclusion PENA has advantages of smaller incision, shorter operation time, less bleeding and less interference on the internal environment, which is especially suitable for elderly patients with poor tolerance for operation. At the same time, its stable fixation makes patients do functional exercise as early as possible and reduce complication. It is an effective method for the treatment of senile unstable intertrochanteric fractures.