人工股骨头置换术治疗老年患者不稳定型股骨粗隆间骨折

Artificial femoral head replacement for unstable intertrochanteric fracture in elderly patients

目的通过对比人工股骨头置换术(artificial femoral head replacement,AFHR)与股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)在治疗高龄患者不稳定型股骨粗隆间骨折的疗效,探究人工股骨头置换术在治疗高龄患者不稳定型股骨粗隆间骨折的可行性。方法回顾性分析2015年1月至2016年6月本院治疗的不稳定型股骨粗隆间骨折高龄患者共47例(均为单侧骨折),男28例,女19例,平均年龄为(80.83±4.83)岁。AFHR组27例,男17例,女10例,平均年龄(81.26±4.87)岁,A2.2型17例,A2.3型10例;PFNA组患者20例,男11例,女9例,平均年龄(79.56±4.75)岁,A2.2型13例,A2.3型7例。对比分析两组患者术前术后血红蛋白、红细胞比积、白蛋白、手术时间和术后下地负重时间等指标,并通过Harris评分、VAS评分评估患者术后恢复情况。结果所有患者均进行了6个月的随访,术后均未发生严重并发症;两组患者术前术后血红蛋白、红细胞比积差值组间比较,差异具有统计学意义(P<0.05);两组患者术后下地负重时间、手术时间、Harris评分比较,差异具有统计学意义(P<0.05)。术前术后白蛋白差值和术后VAS评分方面,两组患者比较差异无统计学意义(P>0.05)。结论人工股骨头置换术具有下地负重时间早、髋关节功能恢复快等优势,可作为治疗高龄不稳定型粗隆间骨折的可选方法;但手术出血量较多、手术时间长,因此需要根据患者实际情况及手术医师熟练程度进行选择。

Objective Via comparing artificial femoral head replacement and proximal femoral nail antirotation in the treatment of unstable intertrochanteric fracture in elderly patients, to analyze the feasibility of artificial femoral head replacement for unstable intertrochanteric fracture of elderly patients. Methods A total of 47 unstable intertrochanteric fracture elderly patients (28 males and 19 females, mean age 80.83±4.83 years ) from January 2015 to June 2016 were retrospective analyzed in this study. Totally 27 patients were undergone artificial femoral head replacement. There were 17 males and 10 females, mean age (81.26±4.87) years, according to AO/OTA classification, 17 patients were considered as A2.2 pattern and 10 patients were considered as A2.3 pattern. Other 20 patients were undergone PFNA internal fixation. There were 11 males and 9 females, mean age (79.56±4.75) years, according to AO/OTA classification, 13 patients were considered as A2.2 pattern and 7 patients were considered as A2.3 pattern. Harris hip score, visual analogue score and the change of hemoglobin, HCT, albumin between pre-operation and post-operation were used to assess the outcome. Results All patients were received six months’ follow-up and none serious complications were founded in this period. There was significant difference in hemoglobin and HCT between pre-operation and post-operation in all patients. In the aspects of Harris hip score, operation time, weight bearing time and the change of hemoglobin and HCT were significantly different between AFHR group and PFNA group. However, there was no significant difference in visual analogue score and the change of albumin between AFHR group and PFNA group. Conclusion AFHR has the superiorities of early weight bearing and rapid recovery, and can be considered as an alternative treatment method for unstable intertrochanteric fracture of elderly patients. But, it should be depended on the patient’s conditions and the proficiency of surgeon, because AFHR are more blood loss and need more operative time and technique skill.