髋关节置换结合股骨近端重建与PFNA治疗老年转子间骨折疗效对比

Efficacy comparison between hip joint replacement combined with proximal femoral reconstruction versus PFNA for treating elderly femoral intertrochanteric fractures

目的比较生物型加长柄髋关节置换结合股骨近端重建和股骨近端防旋髓内钉(PFNA)治疗老年不稳定性股骨转子间骨折的临床疗效。方法回顾性分析2015年3月至2017年4月收治的60例老年股骨转子间骨折患者的临床资料,分A组和B组(所有患者均为Evans分型的Ⅲ、Ⅳ、Ⅴ型,双光子骨密度仪测定腰椎骨密度T<-2.5),每组30例,其中A组采用生物型加长柄髋关节置换结合股骨近端重建治疗,B组采用PFNA治疗。比较两组平均手术时间,术中出血量,切口长度,独立负重时间,术后并发症和术后1、3、6个月、1年的Harris评分。结果A组手术时间略长于B组,但差异无统计学意义(P>0.05);A组术中出血量多于B组,切口长度长于B组,但术后独立负重时间、术后并发症发生率及术后1个月、3个月、6个月的Harris评分A组明显优于B组(P<0.05);两组患者术后1年的Harris评分无明显差异。结论生物型加长柄髋关节置换结合股骨近端重建治疗老年股骨转子间骨折较PFNA能提高术后早期疗效、降低术后并发症的发生率。

Objective To compare the clinical efficacies between biotype lengthened-handled hip joint replacement combined with proximal femoral reconstruction versus proximal femoral nail anti-rotation(PFNA) internal fixation in the treatment of unstable femoral intertrochanteric fracture in elderly people. Methods The clinical data in 60 cases of elderly femoral intertrochanteric fractures in this hospital from March 2015 to April 2017 were retrospectively analyzed.The cases were divided into the group A and B (all cases were the Evans type Ⅲ,Ⅳ,Ⅴ,the lumbar vertebrae bone mineral density (T) detected by the dual-photon bone density instrument was <-2.5),30 cases in each group.The group A adopted biotype lengthened-handled hip joint replacement combined with proximal femoral reconstruction treatment,while the group B adopted the PFNA internal fixation treatment.The mean operation time,blood loss during operation,incision length,independent weight-bearing time,postoperative complications and Harris scores at postoperative 1,3,6 months and 1 year were compared between the two groups. Results The operation time in the group A was slightly longer than that in the group B,but the difference between the two groups had no statistically significant difference ( P >0.05).The intra-operative blood loss in the group A was more than that in the group B,the incision length in the group A was longer than that in the group B,but the postoperative independent weight-bearing time,incidence rate of postoperative complications and the Harris score at 1 postoperative 1,3,6 months in the group A were significantly superior to the group B ( P < 0.05 ).There was no statistically significant difference in the Harris score at 1 year after surgery between the two groups. Conclusion Compared with PFNA,the biotype lengthened-handled hip joint replacement combined with proximal femoral for the treatment of elderly femoral intertrochanteric fracture can increase postoperative early curative effect and reduce the incidence of postoperative complications.