不同手术方案对A2-3型老年骨质疏松性股骨粗隆间骨折患者的疗效及安全性

Efficacy and safety of different surgical approaches in A2-3 type elderly patients with osteoporotic femoral intertrochanteric fracture

目的 探讨半髋关节置换和PFNA对A2-3型老年骨质疏松性股骨粗隆间骨折患者的疗效及安全性.方法 研究对象选取A2-3型老年骨质疏松性股骨粗隆间骨折患者共104例,随机分为A组（52例）和B组（52例）,分别采用半髋关节置换术与PFNA术治疗,比较两组患者术中术后临床指标、Harris评分优良率及术后并发症发生率.结果 A组手术用时、手术失血量、输血量、引流量及骨折愈合时间分别为（103.85±19.23） min、（311.76±43.82） ml、（274.97±44.56） ml、（213.82±57.83） ml、（13.89±1.71）周,B组手术用时、手术失血量、输血量、引流量及骨折愈合时间分别为（56.17±10.67）min、（96.93±17.63） ml、（89.46±15.90） ml、（65.63±12.91） ml、（14.15±1.76）周,B组患者手术用时、手术失血量、输血量及引流量均显著优于A组（P＜0.05）;A组和B组患者Harris评分优良率分别为90.74％、87.04％,两组患者Harris评分优良率比较差异无统计学意义（P＞0.05）;A组和B组患者术后并发症发生率分别为3.70％、7.41％,两组患者术后并发症发生率比较差异无统计学意义（P＞0.05）.结论 半髋关节置换和PFNA治疗A2-3型老年骨质疏松性股骨粗隆间骨折具有相近疗效及安全性;但PFNA术应用有助于降低操作难度和手术创伤程度,加快术后康复进程.

Objective To investigate the efficacy and safety of hemiarthroplasty and PFNA in A2-3 type elderly patients with osteoporotic femoral intertrochanteric fracture.Methods A total of 104 cases of A2-3 type elderly patients with osteoporotic femoral intertrochanteric fracture were selected as subjects and were randomly divided into group A （52 cases） and group B （52 cases）,who were treated with hemiarthroplasty and PFNA respectively.The postoperative clinical indicators,the excellent rate of Harris score,and the incidence of postoperative complications were compared between the two groups.Results The operation time,the amount of blood loss,the amount of blood transfusion,the amount of drainage,and the time of fracture healing in the group A were （103.85±19.23） min,（311.76±43.82） ml,（274.97±44.56） ml,（213.82±57.83） ml,（13.89±1.71） weeks,those in the group B were （56.17± 10.67） min,（96.93± 17.63） ml,（89.46± 15.90） ml,（65.63± 12.91） ml,（14.15± 1.76）weeks,the operation time,the amount of blood loss,the amount of blood transfusion,the amount of drainage in the group B were significantly better than those in the group A （P〈0.05）.The excellent rate of Harris score in the group A and the group B were 90.74% and 87.04% respectively （P〉0.05）.There was no statistically significant difference in the incidence of postoperative complications between the group A and the group B （3.70% vs.7.41%）（P〉0.05）.Conclusion Hemiarthroplasty and PFNA have similar efficacy and safety in the treatment of A2-3 type elderly patients with osteoporotic femoral intertrochanteric fracture;PFNA helps to reduce the difficulty of operation and the degree of surgical trauma,speed up the postoperative rehabilitation.