PFNA内固定和关节置换治疗高龄不稳定型转子间骨折的对比研究

Comparative study of PFNA internal fixation and joint replacement in the treatment of unstable intertrochanteric fractures in the elderly

目的比较股骨近端防旋髓内钉(PFNA)内固定与关节置换治疗高龄不稳定型转子间骨折的临床效果。方法收集2012年3月-2015年6月收治的84例高龄(年龄>75岁)不稳定型转子间骨折患者的临床资料,按治疗方式分为PFNA组(n=44)与关节置换组(n=40),比较两组治疗效果、手术相关指标、术后并发症、髋关节功能评分及术后生活质量。结果 PFNA组手术时间短于关节置换组(P<0.05),患者术中出血量少于关节置换组(P<0.05),关节置换组卧床时间、住院时间、患肢完全负重时间均短于PFNA组(P<0.05);关节置换组与PFNA组并发症发生率对比差异无统计学意义(P>0.05);关节置换组术后1年髋关节功能恢复优良率略高于PFNA组,但差异无统计学意义(P>0.05);术后1年,两组日常生活能力评分均明显上升,与术前对比差异均有统计学意义(P<0.05),关节置换组评分上升幅度高于PFNA组(P<0.05)。结论 PFNA内固定对高龄不稳定型转子间骨折患者内环境影响小,手术时间短,术中出血量少,符合人体生物学特征,微创优势高;关节置换术手术时间长,对内环境干扰大,术中出血量大,但可快速恢复患者髋关节功能。

Objective To compare the clinical effect of proximal femoral nail anti-rotation （PFNA） internal fixation and joint replacement in the treatment of unstable intertrochanteric fractures in the elderly. Methods The clinical data of 84 elderly patients （〉75 years old） with unstable intertrochanteric fractures treated in our hospital from March 2012 to June 2015 were collected. According to different treatment methods, they were divided into PFNA group （n= 44） and joint replacement group （n= 40）. The treatment effects, surgery related indicators, postoperative complications, hip function score and postoperative quality of life were compared between the two groups. Results The duration of surgery and blood loss of PFNA group were shorter and less than those of the joint replacement group （P〈0.05）. The time in bed, length of hospital stay and full weight-bearing time of affected limbs of the joint replacement group were shorter than those of PFNA group （P〈0.05）, while the incidence of complications showed no significant difference （P〉0.05）. 1 year after surgery, the excellent and good rate of hip joint functional recovery in the joint replacement group was slight- ly higher than that in PFNA group （P〉0.05）. 1 year after surgery, the scores of daily living ability were significantly increased （P〈0.05）, and the increase in joint replacement group was more obvious than that in PFNA group （P〈 0.05）. Conclusion PFNA internal fixation has little effect on internal environment of patients with unstable intertro- chanteric fractures. The duration of surgery is short and blood loss is little. It is in accordance with the human biological characteristics and minimally invasive. The duration of hip replacement is long; and it has great effect on the internal en- vironment, with large amount of blood loss but the hip joint function can recover quickly.