老年骨质疏松性不稳定型股骨粗隆间骨折患者关节置换与PFNA内固定的对照研究

Comparative Study on Joint Replacement and PFNA Internal Fixation of Senile Patients with Unstable Intertrochanteric Fracture of Femur due to Osteoporosis

目的探析老年骨质疏松性不稳定型股骨粗隆间骨折患者关节置换与PFNA内固定的治疗效果。方法选取该院在2015年1月—2018年6月期间收治的61例不稳定型股骨粗隆间骨折老年患者,随机分为对照组31例和治疗组30例,对照组行闭合复位PFNA内固定术,治疗组采用骨水泥人工半髋关节置换术,比较两组手术时间、术中失血量、术后并发症发生率、术后30 d、60 d、90 d的髋关节功能评分、治疗有效率。结果治疗组患者的手术时间(52.17±12.30)min高于对照组(37.89±17.33)min;术中失血量(125±38)mL高于对照组(80±24)mL;并发症发生率16.67%明显低于对照组41.94%;术后30 d、60 d、90 d髋关节功能评分显著高于对照组(t=6.307,11.412,9.628,6.935,4.016,P<0.05);对照组患者临床治疗有效率77.4%显著低于治疗组93.3%,差异有统计学意义(χ~2=6.982,P<0.05)。结论与闭合复位PFNA内固定术相比,骨水泥人工半髋关节置换术用于老年骨质疏松性不稳定型股骨粗隆间骨折治疗效果显著,能显著减少手术并发症的发生率,明显提高术后髋关节功能评分,值得临床推广应用。

Objective To study the effect of joint replacement and PFNA internal fixation of senile patients with unstable intertrochanteric fracture of femur due to osteoporosis.Methods 61 cases of senile patients with unstable intertrochanteric fracture of femur due to osteoporosis admitted and treated in our hospital from January 2015 to June 2018 were selected and randomy divided into two groups,the control group with 31 cases used the closed resection PFNA internal fixation surgery,while the treatment group used the bone cement artificial hip joint replacement,and the operation time,intraoperative bleeding amount,incidence rate of postoperative complications,hip joint function scores at 30 d,60 d,90 d after treatment and treatment effective rate were compared between the two groups.Results The operation time in the treatment group was higher than that in the control group[(52.17±12.30)min vs(37.89±17.33)min],and the intraoperative blood loss was higher than that in the control group[(125±38)mL vs(80±24)mL],and the incidence rate of complications was obviously lower than that in the control group(16.67%vs 41.94%),and the postoperative 30 d,60 d,90 d hip joint function score were obviously higher than that in the control group(t=6.307,11.412,9.628,6.935,4.016,P<0.05),and the clinical treatment effective rate in the control group was obviously lower than that in the treatment group(77.4%vs 93.3%),and the difference was obvious(χ^2=6.982,P<0.05).Conclusion The application effect of bone cement hemiarthroplasty is more obvious than that of closed resection PFNA internal fixation surgery,which can obviously reduce the incidence rate of surgical complications and obviously improve the postoperative hip joint function score,and it is worth clinical promotion and application.