两种术式治疗高龄患者股骨转子间骨折的疗效分析

Therapeutic Effect of Two Surgical Treatments for Femoral Intertrochanteric Fractures in Elderly Patients

目的对比股骨近端防旋髓内针术PFNA和人工股骨头置换术两种术式治疗高龄患者股骨转子间骨折的效果。方法回顾分析承德医学院附属医院于2014年4月～2017年4月收治的55例股骨转子间骨折的患者,采用PFNA术患者35例为A组,股骨头置换术患者20例B组,术后早期指导功能锻炼。统计分析两组患者手术时间,术中出血量,术后下地活动时间,住院天数,术后并发症,术后1个月、5个月及9个月Harris评分及并发症情况。结果 A组手术平均时间(96.03±14.01)min,平均术中出血量(104.29±17.87)ml,平均住院天数(12.97±4.28)d,术后1个月Harris评分(61.47±7.02)分,术后下地活动时间(10.49±1.63)d,B组手术平均时间(113.75±12.55)min,平均术中出血量(372.50±144.62)ml,平均住院天数(20.90±2.53)d,术后1个月Harris评分(74.26±9.31)分,术后下地活动时间(7.65±1.57)d,两组比较差异有统计学意义(P<0.05);两组术后5个月、9个月Harris评分及并发症情况比较,差异均无统计学意义(P>0.05)。结论采用PFNA治疗高龄患者转子间骨折手术时间短、固定稳定且更符合股骨近端生物力学特性,术中出血量少,住院周期短,不增加术后并发症。

Objective The effect of PFNA and artificial femoral head replacement on the treatment of femoral intertrochanteric fractures in elderly patients was compared with the treatment of proximal femoral condylar intramedullary acupuncture.Methods A retrospective analysis of 55 patients with femoral intertrochanteric fractures admitted to the Affiliated Hospital of Chengde Medical College from April 2014 to April 2017. 35 patients with PFNA were included in group A, and 20 patients in group B with femoral head replacement surgery. After the early guidance of functional exercise. The operation time, intraoperative blood loss, postoperative activity time, length of hospital stay, postoperative complications, Harris score and complications at 1 month, 5 months and 9 months after operation were analyzed statistically.Results The average time of surgery in group A was （96.03±14.01） min, the mean intraoperative blood loss was （104.29±17.87） ml,the average hospital stay （12.97±4.28）d, Harris score （61.47±7.02） 1 month after operation, postoperative activity time （10.49±1.63） d, group B： average operation time （113.75±12.55） min, The mean intraoperative blood loss （372.50±144.62） ml, the average hospital stay （20.90±2.53） d, the Harris score （74.26±9.31） 1 month after operation, and the postoperative activity time （7.65±1.57） d, the two groups were compared,the difference was statistically significant （P〈0.05）. There was no significant difference in Harris score and complications between the two groups at 5 months and 9 months （P〉0.05）. Conclusion The use of PFNA in the treatment of intertrochanteric fractures in elderly patients is short, stable and more consistent with the biomechanical properties of the proximal femur. The intraoperative blood loss is small, the hospitalization period is short, and the postoperative complications are not increased.