人工股骨头置换术与PFNA内固定治疗高龄股骨转子间骨折的效果分析

Analysis of the Effect of Artificial Femoral Head Replacement and PFNA Internal Fixation on the Treatment of Intertrochanteric Fractures in the Elderly

目的观察高龄股骨转子间骨折应用人工股骨头置换术、股骨近端防旋髓内钉(PFNA)内固定术治疗的效果。方法 2016年1月—2017年5月,该院骨外科共接收82例高龄股骨转子间骨折患者,随机分为A组和B组,A组41例采用人工股骨头置换术治疗,B组41例采用PFNA内固定治疗,观察治疗效果。结果 A组手术时间(95.6±12.5)min、术后6个月Harries评分(89.4±9.3)分、12个月Harris评分(91.6±7.7)分,均高于B组(63.4±17.7)min、(85.5±7.6)分、(87.3±5.9)分,A组下床活动时间(16.3±9.1)d,低于B组(26.5±12.4)d,差异有统计学意义(t=6.035、4.827、5.468、5.927,P <0.05);但两组术中出血量(123.4±26.8)mL vs (124.7±25.9)mL、住院时间(18.3±3.8)d vs(19.1±3.2)d、术后3个月Harris评分(81.7±11.5)分vs (81.3±10.8)分、术后并发症发生率9.8%vs 7.3%,差异无统计学意义(t=0.739、0.652、1.128,χ~2=0.637,P>0.05)。结论高龄股骨转子间骨折患者治疗时,人工股骨头置换术与PFNA内固定术可获得基本相当的疗效,临床应结合患者具体情况选择适当的手术方法,提高手术效果。

Objective To observe the effect of artificial femoral head replacement and proximal femoral anti-rotation intramedullary nail （PFNA） internal fixation for the treatment of femoral intertrochanteric fractures. Methods From January 2016 to May 2017, 82 patients with advanced intertrochanteric fractures were randomly divided into group A and group B. Group A was treated with artificial femoral head replacement, and group B 41 cases of PFNA internal fixation was used to observe the therapeutic effect. Results The operation time of group A was （95.6±12.5） min, the score of Harries score （89.4±9.3）points and the Harris score of 12 months （91.6±7.7）points were higher than that of group B （63.4±17.7） min, （85.5±7.6） points, （87.3±5.9） points, group A of getting out of bed activity time （16.3±9.1）d, lower than group B （26.5±12.4）d, the difference was significant （t=6.035,4.827,5.468,5.927, P〈0.05）; but the intraoperative blood loss （123.4±26.8）mL vs （124.7±25.9）mL, hospitalization time （18.3±3.8） d vs（19.1±3.2） d, postoperative 3 months Harris score （81.7±11.5） points vs（81.3±10.8） points, and the postoperative complication rate was 9.8% vs 7.3%. There was no statistically significant difference （t=0.739,0.652,1.128,χ2=0.637, P〉0.05）. Conclusion In the treatment of elderly patients with intertrochanteric fractures, artificial femoral head replacement and PFNA internal fixation can obtain basically the same effect. Clinically, appropriate surgical methods should be selected according to the specific conditions of patients to improve the surgical results.