PFNA治疗高龄不稳定型股骨转子间骨折的临床疗效观察

Clinical efficacy of PFNA and artificial femoral head replacement in the treatment of unstable intertrochanteric fractures of elderly people

目的探讨防旋股骨近端髓内钉(PFNA)与人工股骨头置换治疗高龄不稳定型股骨转子间骨折的临床疗效。方法选取高龄股骨转子间骨折患者63例,随机分为PFNA组(32例)和置换组(31例),PFNA组行闭合复位PFNA内固定术,置换组行人工双极股骨头置换术。记录和比较两组患者手术时间、术中出血量、切口长度、卧床时间、髋关节功能及并发症等指标;采用髋关节功能评分量表(Harris)评估术后髋关节功能。结果在手术时间、术中出血量、切口长度、卧床时间上PFNA组短于置换组,两组差异有统计学意义;两组术后6个月随访髋关节功能有显著性差异。末次随访PFNA组无骨折不愈合、延迟愈合、断钉、头钉切出情况发生,1例螺旋刀片退出,但不影响髋关节功能;置换组无关节脱位,有1例大粗隆钢丝松动,考虑骨质疏松所致,1例假体周围骨折,1例假体松动。结论 PFNA治疗高龄不稳定型股骨转子间骨折具有手术时间短、出血少、切口小、并发症少的特点,值得临床进一步推广。

Objective To compare the clinical efficacy of PFNA and artificial femoral head replacement in the treatment of unstable intertrochanteric fracture of elderly people.Methods Sixty-three elderly patients with intertrochanteric fractures in our hospital were randomly divided into PFNA group(32 cases)and replacement group(31 cases).PFNA group was treated with closed reduction PFNA fixation and replacement group was treated with artificial bipolar femoral head replacement.The operation time,intraoperative bleeding volume,incision length,bed rest time,hip joint function and complications were recorded and compared between the two groups.Results The PFNA group was shorter than the replacement group in operation time,intraoperative bleeding volume,incision length and bed rest time(P<0.05).There was significant difference in hip function(Harris score)after 6 months'follow-up between the two groups.There wasn't nonunion,delayed union,broken nail and head nail incision in the last follow-up in PFNA group.There was 1 case of screw blade exit.In the replacement group,there was no joint dislocation,but there was 1 case of greater trochanter loosening due to osteoporosis,1 case of periprosthetic fracture and 1 case of prosthetic loosening.Conclusion PFNA is the first choice for the treatment of intertrochanteric fractures with the characteristics of shorter operative time,less bleeding,less incision and less complications.