人工股骨头置换与PFNA内固定治疗老年人FIF的临床研究

Clinical Study of Artificial Femoral Head Replacement and PFNA Internal Fixation in the Treatment of Elderly Patients with FIF

目的对比人工股骨头置换与防旋型股骨近端髓内钉(PFNA)内固定治疗老年人股骨粗隆间骨折(FIF)近远期疗效。方法 2012年1月—2017年1月,方便选取医院采用人工股骨头置换治疗老年人FIF 67例,纳入股骨头置换组,选择PFNA治疗对象95例,纳入PFNA组。对比手术、康复情况,死亡、并发症发生情况。结果股骨头置换组卧床时间、住院时间分别为(5.4±1.2)、(11.1±5.2)d,低于PFNA组(10.1±3.6)、(15.2±3.1)d,股骨头置换组出血量、手术时间分别为(367.1±40.4)mL、(74.4±11.7)min高于PFNA组(215.8±28.2)mL、(56.8±10.2)min,差异有统计学意义(t=8.25、6.10、18.43、11.56,P=0.000、0.000、0.000、0.000<0.05)。两组末次随访Harris髋关节功能评分分别为(92.8±5.4)分、(90.1±6.3)分,差异无统计学意义(t=1.105,P=0.242>0.05)。结论人工股骨头置换治疗老年人FIF康复速度快,会增加手术风险,手术时间更长,需要加强技术管理。

Objective This paper tries to compare the short-term and long-term effects of artificial femoral head replacement with anti-rotation proximal femoral nail（PFNA） internal fixation in the treatment of intertrochanteric fracture（FIF） in the elderly. Methods From January 2012 to January 2017, the hospital used artificial femoral head replacement to treat 67 elderly patients with FIF and was included in the femoral head replacement group. 95 subjects treated with PFNA were included in the PFNA group. Compare surgery, rehabilitation, death, and complications. Results Bed rest time and length of hospital stay in the femoral head replacement group were（5.4±1.2）days and（11.1±5.2）days were lower than those in the PFNA group（10.1±3.6）days and（15.2±3.1）days, and the amount of blood in the femoral head replacement group was decreased.The duration of operation was（367.1±40.4）mL,（74.4±11.7）min higher than that of PFNA group（215.8±28.2）mL,（56.8±10.2）min, and the difference was statistically significant（t=8.25, 6.10, 18.43, 11.56, P=0.000, 0.000, 0.000, 0.000 0.05）. Harris hip function scores at the last follow-up in the two groups were（92.8±5.4）points and（90.1±6.3）points, respectively. There was no significant difference（t=1.105, P=0.242〉0.05）. Conclusion Artificial femoral head replacement for elderly patients with FIF has a rapid recovery rate, which increases the risk of surgery, and requires a longer operation time. It needs to strengthen technical management.