PFNA内固定与人工股骨头置换术治疗高龄骨质疏松性股骨粗隆间骨折的比较

Comparison of PFNA and artificial femoral head replacement in treatment of senile osteoporotic femoral intertrochanteric fractures

目的 探讨应用股骨近端防旋髓内钉（PFNA）治疗高龄骨质疏松性股骨粗隆间骨折的疗效。方法 回顾性分析本院自2010-01—2014-12实施PFNA内固定治疗的52例高龄股骨粗隆间骨折,并对照同期实施人工股骨头置换（FHR）的47例患者,比较2组手术时间、术中术后出血量、住院时间、术后并发症及术后髋关节功能Harris评分等综合指标。结果 所有患者获得平均18（12~24）个月随访。2组手术前后颈干角、前倾角均恢复满意。PFNA组在术中出血量、术后出血量、住院时间上与FHR组无明显差别,差异无统计学意义（P〉0.05）;但PFNA组在手术时间上较FHR组短,差异有统计学意义（P〈0.05）;PFNA组在关节脱位、深静脉血栓、术后肺部感染方面发生率较FHR组低,差异有统计学意义（P〈0.05）;PFNA组术后6、12、18个月髋关节功能Harris评分优于FHR组,差异有统计学意义（P〈0.05）。结论 采用PFNA治疗老年骨质疏松性粗隆间骨折与FHR相比,术后并发症少,功能恢复好,值得临床推广。

Objective To explore the effect of proximal femoral anti-rotation intramedullary nail （PFNA） in treatment of the osteoporotic intertrochanteric fractures of patients aged over 80 years old. Methods Fifty two elderly femoral intertrochanteric fracture patients who underwent PFNA from Jan. 2011 to Dec. 2014 were retrospectively analyzed. The recovery of femoral neck shaft angle and anteversion angle was observed and the operation time, postoperative bleeding, the hospitalization time and postoperative complications ,the postoperative Harris hip score and other comprehensive indicators were compared with the control group （47 cases） who received femoral head replacement （FHR） at the same period. Results The recovery of the femoral neck shaft angle and the anterior angle in both groups were satisfactory. As to postoperative complications, the incidence of joint dislocation, deep venous thrombosis and postoperative pulmonary infection in PFNA group were lower than those in FHR group （P 〈0.05）, the Harris hip score was better after 6 months, 12 months and 18 months follow-up, the difference was statistically significant between two groups （P 〈0.05）. Conclusion PFNA is a reliable method for aged osteoporotic intertrochanteric fractures patients.