用人工髋关节置换术与PFNA内固定术对老年股骨粗隆间骨折患者进行治疗的效果对比

Comparison of the efficacy of hip arthroplasty and PFNA internal fixation in the treatment of elderly patients with intertrochanteric fracture of femur

目的 :比较用人工髋关节置换术与股骨近端防旋髓内钉(PFNA)内固定术对老年股骨粗隆间骨折患者进行治疗的效果。方法 :将邛崃市医疗中心医院收治的68例老年股骨粗隆间骨折患者随机分为关节置换组和PFNA组(34例/组)。为关节置换组患者采用人工髋关节置换术进行治疗,为PFNA组患者采用PFNA内固定术进行治疗。然后对比两组患者手术的时间、术中的出血量、术后的Harris评分、髋关节功能恢复的优良率及并发症的发生率。结果:关节置换组患者手术的时间长于PFNA组患者,其术中的出血量多于PFNA组患者,其术后并发症的发生率高于PFNA组患者,P <0.05。在术后,关节置换组患者的Harris评分和髋关节功能恢复的优良率均高于PFNA组患者,其术毕至下床活动的时间短于PFNA组患者,P <0.05。结论 :用人工髋关节置换术与PFNA内固定术对老年股骨粗隆间骨折患者进行治疗各有优缺点。临床医生应根据此病患者的实际情况为其选用合理的治疗方式。

Objective:To compare the therapeutic effects of hip arthroplasty and proximal femoral antirotation intramedullary nail(PFNA) internal fixation on elderly patients with intertrochanteric fractures. Methods: 68 elderly patients with intertrochanteric femoral fracture admitted by qionglai medical center hospital were randomly divided into the joint replacement group and the PFNA group(34 cases/group). Patients in the joint replacement group were treated with hip arthroplasty, while patients in the PFNA group were treated with PFNA internal fixation. Then, the operative time, intraoperative blood loss, postoperative Harris score, excellent and good rate of hip function recovery and incidence of complications were compared between the two groups. Results: patients in the joint replacement group had longer operative time than patients in the PFNA group, the amount of intraoperative blood loss was higher than patients in the PFNA group, and the incidence of postoperative complications was higher than patients in the PFNA group(P < 0.05). After surgery, the Harris score and the excellent and good rate of hip function recovery in the joint replacement group were higher than those in the PFNA group, and the time from operation to bed movement was shorter than those in the PFNA group(P < 0.05). Conclusion: hip arthroplasty and PFNA internal fixation have their own advantages and disadvantages in the treatment of elderly patients with intertrochanteric fractures. The clinician should choose a reasonable treatment method according to the actual situation of the patient with this disease.