手术时机对老年股骨转子间骨折的疗效分析

Timing of surgery for elderly peritrochanteric fractures and in-hospital mortality

[目的]探讨不同手术时机行股骨近端防旋髓内钉(PFNA)内固定对老年股骨转子间骨折临床疗效的影响。[方法]回顾性分析本院收治的98例老年股骨转子间骨折患者,按手术时机分为早期组(伤后48 h内手术)52例与延期组(伤后48 h^7 d手术)46例。统计两组患者住院相关临床指标、髋关节功能评分、术后并发症及死亡率。[结果]早期组术前住院时间、手术时间、术中出血量、住院时间、住院费用、并发症发生率均少于延期组,术后3个月、1年的髋关节功能评分高于延期组,差异有统计学意义(P<0.01),两组的术后死亡率差异无统计学意义(P>0.05)。[结论]早期手术治疗老年股骨转子间骨折能缩短手术时间及住院时间,减少术中出血量,降低住院费用,有利于患者早期功能锻炼,可以减少术后并发症的发生,促进髋关节功能的恢复,但对死亡率并无明显影响。

[Objective]To explore the clinical effects and mortality for elderly peritrochanteric fractures in different surgical timing by using Proximal Femoral Nail Antirotation（ PFNA） internal fixation. [Method]Ninety- eight patients with peritrochanteric fractures were randomly divided into two groups. The early surgery group included 52 cases and all patients were operated within 48 hours after injury,while in the delayed surgery group,46 cases were enrolled and all patients received operation in 48 hours and 7 days after injury. Hospital clinical indicators,the hip function scores,postoperative complications and mortality were evaluated. [Result]The changes in preoperative hospitalization time,operation time,intraoperative blood loss,hospital stay,hospital expenses,incidence of complications,and the hip function scores at 3 months and one year after surgery in the early group were significantly different from those of the delayed group（ P 〈 0. 01）. No significant difference in mortality was found between the two groups（ P 〉 0. 05）. [Conclusion]Early surgical treatment of elderly intertrochanteric fractures can shorten the operation time and hospital stay,reduce intraoperative blood loss and the cost of hospitalization,reduce the incidence of postoperative complications,and it is beneficial to early functional exercises,thus improve the recovery of hip function. However,it has no significant effect on mortality.