骨水泥型人工股骨头置换和PFNA治疗高龄股骨转子间骨折的疗效观察

Clinical effect of cemented hemiprosthetic hip joint arthroplasty vs. proximal femoral nail anti-rotation in the treatment of elderly patients with intertrochanteric fractures

目的探讨骨水泥型人工股骨头置换和股骨近端防旋转髓内钉（proximal femoral nail anti?rotation, PFNA）治疗高龄股骨转子间骨折的临床疗效。方法回顾性分析三峡大学人民医院骨科自2008年1月至2013年11月采用骨水泥型人工股骨头置换术和PFNA固定术治疗的高龄股骨转子间骨折患者72例的临床资料，其中人工股骨头置换32例（人工股骨头置换组），PFNA固定术治疗40例（PFNA组）。比较两组患者的手术时间、术中出血量、术后引流量及关节功能评分等。结果72例患者随访时间为12~36 个月，平均20.8 个月。PFNA 组出现骨折延迟愈合3 例。人工股骨头置换组手术时间为（49.1±10.6）min，优于PFNA 组的（57.6±7.2）min；术后1 个月及末次随访关节功能Harris 评分分别为（61.20±4.37）分、（87.92±3.02）分，优于PFNA组的（54.60±3.18）分、（78.86±8.13）分，差异均有统计学意义（均P＜0.05）；而术中出血量、术后引流量分别为（204.2±36.1）ml、（110.5±26.3）ml，多于PFNA 组的（98.2±32.3）ml、（58.7±15.7）ml，差异均有统计学意义（P＜0.05）。结论两种方法均可有效治疗高龄股骨转子间骨折，术前根据患者情况选择适当治疗方式均恢复关节功能，提高患者生活质量。

Objective To explore the clinical efficacy of cemented Hemiprosthetic hip joint arthroplastyvs. proximal femoral nail antirotation (PFNA) in the treatment of elderly patient with intertrochanteric fractures.Methods This retrospective study included 72 cases of intertrochanteric fracture between January 2008 toNovember 2013. The patients were treated by cemented hemiprosthetic hip joint arthroplasty (group Hemipros?thetic, n=32) and PFNA (group PFNA, n=40). The operation time, intraoperative blood loss, postoperative suc?tion drainage, and Harris hip scores were used to determine the efficacy. Results The 72 patients were fol?lowed up for average 20.8 months (12 to 36 months). Fracture delayed nonunion occurred in 3 cases of groupPFNA. The operation time in the group Hemiprosthetic and group PFNA was respectively (49.1±10.6) min and(57.6±7.2) min, intraoperative blood loss was (204.2±36.1) ml and (98.2±32.3) ml, and postoperative suctiondrainage was (110.5±26.3) ml and (58.7±15.7) ml, respectively. Harris hip scores at 1st month and final follow?up after operation were respectively 61.20±4.37 and 87.92±3.02 in group Hemiprosthetic, and 54.60±3.18 and78.86±8.13 in group PFNA. The cemented hemiprosthetic hip joint arthroplasty had advantages in operationtime and Harris hip score, but not in intraoperative blood loss and postoperative suction drainage. ConclusionBoth two methods are effective for the intertrochanteric fracture. According to the fracture type and physicalcondition of patients, they can restore the joint function and improve the quality of life.