两种方法治疗老年股骨粗隆间骨折的近期疗效对比

Curative effect comparison of the two methods for the treatment of femoral intertrochanteric fractures in the elderly

目的探讨人工股骨头置换术(Femoral head replacement, FHR)与防旋型股骨近端髓内钉术(proximal femoral nail anti-rotation, PFNA)治疗老年股骨粗隆间骨折患者的近期疗效以及对生活质量的影响。方法选取本院2015年1月～2018年1月收治的102例股骨粗隆间骨折患者临床资料进行回顾性分析。根据手术方式不同分为FHR组(n=54)和PFNA组(n=48)。比较两组围手术期指标,术后1个月内并发症情况,术后1个月、3个月、6个月Harris髋关节评分及健康调查简表(the MOS item short from health survey, SF-36)评分。结果 FHR组手术时间长于PFNA组,术中出血量多于PFNA组,术中透视次数、卧床时间以及住院费用均少于PFNA组,差异均有统计学意义(<0.05);FHR组术后深静脉血栓发生率低于PFNA组,差异均有统计学意义(<0.05);术后1个月、3个月,FHR组Harris评分和SF-36量表总评分均高于PFNA组,差异具有统计学意义(<0.05),术后6个月,两组Harris评分和SF-36量表总评分均差异无统计学意义(>0.05)。结论 FHR治疗老年股骨粗隆间骨折患者可减少辐射损伤、卧床时间、住院费用、深静脉血栓发生率,且术后早期髋关节功能和生活质量明显优于PFNA。

Objective To investigate the short-term curative effect of artificial femoral head replacement(FHR)and proximal femoral nail anti-rotation(PFNA)in the treatment of elderly patients with femoral intertrochanteric fractures and the effect on quality of life.Methods The clinical data of102patients with femoral intertrochanteric fractures who were admitted to the hospital from January2015to January2018were retrospectively analyzed.According to different surgical methods,they were divided into FHR group(n=54)and PFNA group(n=48).The perioperative indicators,incidence of complications within1month after surgery,the Harris hip scores and the MOS item short from health survey(SF-36)scores at1month,3months and6months after surgery were compared between the two groups.Results The surgical time of FHR group was longer than that of PFNA group.The intraoperative blood loss was more than that of PFNA group.The times of intraoperative fluoroscopy,time in bed and hospitalization expenses were less than those of PFNA group(P<0.05).The incidence of deep venous thrombosis in FHR group after surgery was lower than that in PFNA group(P<0.05).The Harris scores and SF-36scores of FHR group were significantly higher than those of PFNA group at1month and3months after surgery(P<0.05).There was no significant difference between the two groups in Harris score or SF-36score at6months after surgery(P>0.05).Conclusion FHR can reduce radiation injury,time in bed,hospitalization expenses and the incidence of deep venous thrombosis in elderly patients with femoral intertrochan-teric fractures.The hip function and quality of life are significantly better than those of patients treated by PFNA.