PFNA和双极股骨头半髋置换手术治疗高龄不稳定股骨粗隆间骨折的优劣差异

Difference of PFNA and bipolar femoral head hemiarthroplasty in the treatment of unstable intertrochanteric fractures of the aged femur

目的探讨股骨近端防旋髓内钉和双极股骨头半髋置换手术治疗高龄不稳定股骨粗隆间骨折的临床应用效果。方法选取我院于2015年1月~2016年12月间收治的40例高龄不稳定股骨粗隆间骨折患者作为研究对象,按照随机数字表法分为对照组和研究组,对照组20例予以双极股骨头半髋置换手术治疗,研究组20例予以PFNA治疗。比较两组患者手术一般情况,并发症发生情况及不同时刻视觉模拟评分(VAS)和Harris评分。结果两组手术时间、术中出血量、负重下地时间、围术期并发症发生率比较有统计学意义(P<0.05),两组手术并发症无统计学意义(P>0.05)。两组术后2周、术后6个月时VAS评分和Harris评分比较有统计学意义(P<0.05),两组患者术后12个月时VAS评分和Harris评分比较无统计学意义(P>0.05)。结论 PFNA和双极股骨头半髋置换手术治疗高龄不稳定股骨粗隆间骨折均有良好的疗效。应根据患者病情及适应证选择适合的手术方式。

Objective To explore the clinical effect of proximal femoral nail（PFNA） and bipolar femoral head hemiarthroplasty in the treatment of unstable intertrochanteric fractures of the aged femur. Methods Forty patients with unstable intertrochanteric fractures admitted from January 2015 to December 2016 in our hospital were selected as the research objects, they were divided into control group and study group according to random number method, 20 cases of control group were given bipolar femoral head hemiarthroplasty, 20 cases of study group received PFNA treatment. The general conditions of operation, complications and visual analogue scale（VAS） at different times and Harris score were compared between the two groups. Results There were significant difference between the two groups in operation time, intraoperative blood loss, time under load and the incidence of perioperative complications（P〈0.05）. There was no significant difference in operative complications between the two groups（P〈0.05）. There were significant differences in VAS score and Harris score between the two groups at 2 weeks and 6 months after operation（P〈0.05）. There was no significant difference in VAS score and Harris score between the two groups at 12 months after operation（P〈0.05）. Conclusion PFNA and bipolar femoral head hemiarthroplasty have good curative effect in the treatment of unstable intertrochanteric fractures of the aged femur. The appropriate surgical methods should be selected according to the patient＇s condition and indications.