PFNA与人工关节置换术治疗老年不稳定型转子间骨折的疗效

Effect of PFNA and artificial joint replacement in treatment of unstable intertrochanteric fracture in elderly patients

目的比较股骨近端防旋髓内钉(PFNA)与人工关节置换术治疗老年不稳定型转子间骨折的临床疗效。方法 50例老年不稳定型转子间骨折患者,根据手术方式分为PFNA组(26例)及关节置换组(24例),比较两组患者手术时间、切口长度、术中出血量、住院时间及下床时间,术后随访观察患者髋关节功能Harris评分(HHS)及VAS疼痛评分。结果与关节置换组比较,PFNA组切口长度短、手术时间短、术中出血量较少、下床时间较晚(P<0.05),两组住院时间比较无统计学差异(P>0.05)。术后2周及术后3个月,关节置换组HHS和VAS疼痛评分均优于PFNA组(P<0.05)。结论 PFNA及关节置换术均是治疗老年不稳定型转子间骨折的有效方式,两种术式存在优缺点,应根据患者具体情况选择。

Objective To compare the effect of proximal femoral nail antirotation（PFNA）and artificial joint replacement in the treatment of unstable intertrochanteric fracture in elderly patients.Methods Fifty elderly patients with unstable intertrochanteric fracture were treated with PFNA（group A,26cases）and artificial joint replacement（group B,24cases）,respectively.The operation time,length of the incision,intraoperatve blood loss,hospital stay and the time of getting out of bed were compared between two groups.The Harris hip score（HHS）and visual analogue scale（VAS）pain score were evaluated postoperatively.Results Compared to group B,group A had shorter length of the incision and operation time,less intraoperative blood loss and later time of getting out of bed（P〈0.05）.There was no significant difference in hospital stay between two groups（P〈0.05）.The HHS and VAS pain scores were better in group B than those in group A in the 2nd week and 3rd month after operation（P〈0.05）.Conclusion PFNA and artificial joint replacement are both effective in treating unstable intertrochanteric fractures in elderly patients.The suitable operation should be chosen according to the condition of the patients.