PFNA近端锁定板和人工股骨头置换术对高龄骨质疏松性股骨粗隆间骨折患者围术期指标髋功能恢复及下肢静脉血栓的影响

Effects of PFNA,Proximal Locking Plate and Artificial Femoral Head Replacement on Perioperative Indexes,Hip Function Recovery and Lower Limb Venous Thrombosis in Elderly Osteoporotic Patients with Femoral Intertrochanteric Fractures

目的:探究股骨近端防旋髓内钉(PFNA)、股骨近端锁定钢板(PF-LCP)和人工股骨头置换术对高龄骨质疏松性股骨粗隆间骨折患者围术期指标、髋功能恢复及下肢静脉血栓的影响。方法:按照手术术式不同将95例高龄骨质疏松性股骨粗隆间骨折患者分为PFNA组、PF-LCP组及人工股骨头置换术,比较各组患者围术期指标,统计患者术后并发症发生情况并测定D-二聚体水平,对患者进行随访,于末次随访评价患者髋关节功能。结果:PFNA组手术时间、术中出血量、术后引流量显著低于PFLCP组及人工股骨头置换术组(P <0.05);人工股骨头置换术下地负重时间及住院时间显著短于PFNA组及PF-LCP组(P<0.05);PF-LCP及人工股骨头置换术组患者术后7d时D-二聚体水平显著高于PFNA组(P <0.05);所有患者均获得随访,随访时间为17～22个月,PFNA组及人工股骨头置换术组患者髋功能Harris评级显著优于PF-LCP组(P<0.05)。结论:PFNA及人工股骨头置换术均能有效改善股骨粗隆间骨折患者髋功能,PFNA手术治疗时间短、出血量少,术后深静脉血栓发生风险较低,人工股骨头置换术治疗卧床时间短、患者恢复快。

Objective:To investigate the effects of proximal femoral nail anti-rotation(PFNA),proximal femoral locking compress plate(PF-LCP)and artificial femoral head replacement on perioperative indexes,hip function recovery and lower limb venous thrombosis in Elderly osteoporotic patients with femoral intertrochanteric fractures.Methods:95 Elderly osteoporotic patients with femoral intertrochanteric fractures were divided into PFNA group,PF-LCP group and artificial femoral head replacement group according to different surgical procedures.The perioperative indexes were compared among groups.The incidence of postoperative complications was statistically analyzed,and D-dimer levels were measured.The patients were followed up,and hip function was evaluated at the last follow-up.Results:The surgical time,intraoperative blood loss and postoperative drainage volume of PFNA group were significantly shorter/less than those of PF-LCP group or the artificial femoral head replacement group(P<0.05).The weight-bearing time and hospital stay of the artificial femoral head replacement group was significantly shorter than that of PFNA group or PF-LCP group(P<0.05).The D-dimer levels in PF-LCP group and the artificial femoral head replacement group at 7 days after surgery were significantly higher than those in PFNA group(P<0.05).All patients were followed up,and the follow-up time was 17 to 22 months.The Harris grade of hip function in PFNA group or the artificial femoral head replacement group was significantly better than that in PF-LCP group(P<0.05).Conclusion:Both PFNA and artificial femoral head replacement can effectively improve the hip function in patients with femoral intertrochanteric fractures.The duration of PFNA is short,blood loss is little and the risk of postoperative deep venous thrombosis is low.The time in bed of patients treated by artificial femoral head replacement is short and the patient can recover quickly.