人工股骨头置换修复高龄不稳定型股骨转子间骨折的疗效

Femoral head replacement for the treatment of unstable intertrochanteric fractures in elderly patients

目的评估高龄不稳定型股骨转子间骨折患者采用人工股骨头置换术与股骨近端防旋髓内钉(PFNA)术的治疗效果,为此类骨折的治疗与康复方案选择提供依据。方法选取2011年2月至2015年10月咸阳市中心医院骨科诊断为高龄不稳定型股骨转子间骨折的患者共80例,按入院时间排序随机分为两组,观察组接受人工股骨头置换术,对照组接受PFNA术。其中男33例,女47例,年龄均>80岁。评估两组患者的住院时间、手术时间、下地负重时间、术后并发症及术后髋关节Harris评分情况。结果观察组手术时间长于对照组,住院时间、术后卧床时间、负重时间均短于对照组。全部患者获得12~18个月的术后随访,术后6个月Harris评分两组无差异,术后1年Harris评分观察组优于对照组。术后并发症发生率观察组低于对照组(P<0.05)。结论与行PFNA相比,高龄股骨转子间骨折患者采用人工股骨头置换术在缩短卧床时间、患髋功能锻炼、减少并发症等方面更具优势,疗效也更加可靠。

Objective To evaluate the clinical efficacy of femoral head replacement and proximal femoral nail anti-rotation(PFNA)in the treatment of unstable intertrochanteric fractures in elderly patients,and therefore provide treatment and rehabilitation suggestions for such fractures.Methods From February2011 to October 2015,a total of 80 patients suffering unstable intertrochanteric fractures were included and divided into two groups according to the sequence of admission time.Patients in the observation group underwent femoral head replacement,while patients in the control group underwent PFNA.There were 33 males and 47 females,all of whom were over 80 years old.The length of hospital stay,operation duration,weight-bearing time,postoperative complications and the Harris scores were recorded and compared between the two groups.Results The operation duration of the observation group was longer than that of the control group.The length of hospital stay,postoperative non-ambulatory duration and weight-bearing time of the observation group were shorter than those of the control group.All patients were followed up for 12~18 months.There was no difference in the Harris scores between the two groups at 6 months postoperatively,whereas the Harris scores of the observation group were higher than that of the control group at 12 months.The rate of postoperative complications of the observation group was lower than that of the control group(P<0.05).Conclusion Compared with PFNA,femoral head replacement for the treatment of unstable intertrochanteric fractures is superior in terms of non-ambulatory duration,postoperative complications and hip function.