对比分析老年股骨粗隆间骨折患者行人工股骨头置换与股骨近端防旋髓内钉内固定方法的临床效果

Comparative analysis of elderly patients with femoral intertrochanteric fracture treated with hemiarthroplasty and proximal femoral nail anti-rotation internal fixation

目的分析将人工股骨头置换(HA)与股骨近端防旋髓内钉(PFNA)内固定方法应用在股骨粗隆间骨折老年患者治疗中的效果。方法 74例股骨粗隆间骨折老年患者,根据治疗方式的不同分成人工置换组和髓内钉内固定组,各37例,人工置换组采用人工股骨头置换治疗;髓内钉内固定组采用股骨近端防旋髓内钉内固定治疗,比较两组治疗的效果。结果人工置换组患者卧床时间为(1.64±0.72)d、患肢开始完全负重时间为(3.25±2.15)d均短于髓内钉内固定组的(5.87±1.02)、(40.03±4.38)d,差异有统计学意义(P<0.05)。治疗后,人工置换组中患者并发症发生率为5.41%低于髓内钉内固定组的21.62%,差异有统计学意义(P<0.05)。两组患者术后3个月、术后6个月Harris评分均优于治疗前,人工置换组改善幅度均优于髓内钉内固定组,差异有统计学意义(P<0.05)。结论将人工股骨头置换与股骨近端防旋髓内钉内固定方法应用在股骨粗隆间骨折老年患者治疗中,均有较好的效果,人工股骨头置换术在减少卧床时间、减少并发症等方面更优于髓内钉内固定术,可推广。

Objective To analyze the effect of hemiarthroplasty（HA） and proximal femoral nail antirotation（PFNA） internal fixation applied in elderly patients with femoral intertrochanteric fracture. Methods A total of 74 elderly patients with femoral intertrochanteric fracture were divided by different treatment methods into artificial replacement group and intramedullary nail fixation group, with 37 cases in each group. Artificial replacement group received hemiarthroplasty, and intramedullary nail fixation group received proximal femoral nail anti-rotation internal fixation. Effect was compared in two groups. Results Artificial replacement group had bed time as（1.64±0.72） d, affected limb start full weight-bearing time as（3.25±2.15） d, which were all shorter than（5.87±1.02） and（40.03±4.38） d in intramedullary nail fixation group, and their difference had statistical significance（P〈0.05）. After treatment, artificial replacement group had lower incidence of complications as 5.41% than 21.62% in intramedullary nail fixation group, and the difference had statistical significance（P〈0.05）. Both groups had improved Harris score in postoperative 3 and 6 months than before treatment, and artificial replacement group had better improvement degree than intramedullary nail fixation group. Their difference had statistical significance（P〈0.05）. Conclusion Both hemiarthroplasty and proximal femoral nail anti-rotation internal fixation shows good effect in elderly patients with femoral intertrochanteric fracture, and hemiarthroplasty shows better effect in reducing bed time and complications than intramedullary nail fixation. So it can be promoted.