半髋关节置换与PFN内固定治疗不稳定型股骨粗隆间骨折的临床对比研究

Clinical Comparative Study on Hemiarthroplasty and PFN Internal Fixation in the Treatment of Unstable Femoral Intertrochanteric Fractures

目的研究半髋关节置换与股骨近端髓内钉(PFN)内固定治疗不稳定型股骨粗隆间骨折患者的临床效果。方法选取我院2013年4月至2016年10月期间收治的108例不稳定型股骨粗隆间骨折患者,随机分为两组各54例。研究组采用半髋关节置换治疗,对照组采用PFN内固定治疗。观察与比较两组患者的手术情况、生存质量和并发症情况。结果两组患者的手术时间比较无统计学差异(P>0.05)。对照组出血量、输血量及切口长度均小于研究组,但研究组术后卧床时间短于对照组(P均<0.05)。术后两组患者的ADL、QOL评分比较均无统计学差异(P>0.05)。研究组的并发症发生率为7.41%,明显低于对照组的22.22%(P<0.05)。结论半髋关节置换与PFN内固定治疗不稳定型股骨粗隆间骨折均有较好的疗效。半髋关节置换的术后并发症少,术后卧床时间短,而PFN内固定的出血量及输血量少,创伤小。患者需要根据自身实际情况选择手术方案。

Objective To study the clinical effect of hemiarthroplasty and proximal femoral nail （PFN） internal fixation in the treatment of patients with unstable femoral intertrochanteric fractures. Methods 108 cases of patients with unstable femoral intertrochanteric fractures admitted to our hospital from April 2013 to October 2016 were selected and randomly divided into two groups, with 54 cases in each group. The study group received hemiarthroplasty, while the control group received PFN internal fixation. The operation condition, quality of life and complications were observed and compared between two groups. Results No statistical difference was found in the operation time between two groups （P〉0.05）. The blood loss, blood transfusion volume and incision length of control group were less than those of study group, but the postoperative bed rest time of study group was shorter than that of control group （all P 〈0.05）. No statistical difference was found in the ADL score and QOL score between two groups. The incidence of complications of study group was 7.41%, significantly lower than 22.22% of control group （P〈0.05）. Conclusions Both hemiarthroplasty and PFN internal fixation have better effect in the treatment of patients with unstable femoral intertrochanteric fractures. Hemiarthroplasty has fewer postoperative complications and shorter bed rest time, but PFN internal fixation has less blood loss and blood transfusion volume, and smaller less trauma. Patients need to choose surgical programs based on their actual situation.