PFNA与骨水泥加长柄人工股骨头置换治疗高龄骨质疏松性股骨转子间骨折的比较研究

A comparative study of PFNA and cement combined with long-stem artificial femoral head replacement in the treatment of osteoporotic intertrochanteric fractures in the elderly

目的探讨股骨近端防旋髓内钉(PFNA)与骨水泥加长柄人工股骨头置换治疗高龄骨质疏松性股骨转子间骨折(IFOF)的疗效。方法回顾性分析2014年1月—2017年9月成都市郫都区人民医院收治的86例高龄骨质疏松性IFOF患者的临床资料。其中男性39例,女性47例;年龄70~92岁,平均82.83岁;道路交通伤35例,摔伤51例。根据治疗方式进行分组,采用PFNA治疗的37例为对照组,采用骨水泥加长柄人工股骨头置换治疗的49例为观察组。比较两组手术情况、生活质量健康状况调查简表(SF-36)评分、术后不同时间点髋关节功能Harris评分和并发症发生情况。结果对照组手术时间、切口长度、术中出血量分别为(68.57±13.78)min、(6.54±1.08)cm、(135.82±33.59)mL,优于观察组的(96.25±17.84)min、(10.25±1.36)cm、(187.93±40.26)mL(P<0.05);观察组术后下地时间、患肢完全负重时间、住院时间分别为(3.26±0.73)d、(4.13±0.87)d、(6.24±1.14)d,均短于对照组的(11.75±1.17)d、(43.68±6.54)d、(14.75±2.17)d(P<0.05)。Harris评分观察组术后1、3、6个月高于对照组,两组术后3个月高于术后1个月,术后6个月高于术后3个月(P<0.05);对照组Harris评分术后12个月高于术后6个月(P<0.05)。术后6个月观察组SF-36各维度评分高于对照组(P<0.05);两组不同时间点SF-36各维度评分组内比较差异有统计学意义(P<0.05)。对照组并发症发生率为10.81%(4/37),与观察组的10.20%(5/49)比较,差异无统计学意义(P>0.05)。结论高龄骨质疏松性IFOF患者采用PFNA治疗手术创伤较小,采用骨水泥加长柄人工股骨头置换治疗术后恢复快。

Objective To explore the effect of proximal femoral nail anti-rotation(PFNA)and cement combined with long-stem artificial femoral head replacement in the treatment of elderly patients with osteoporotic intertrochanteric fracture of femur(IFOF).Methods Clinical data of 86 elderly patients with osteoporotic IFOF who were admitted to Pidu District People s Hospital of Chengdu City from Jan.2014 to Sep.2017 were retrospectively analyzed.There were 39 males and 47 females.The age ranged from 70 to 92 years,with an average of 82.83 years.There were 35 cases of road traffic injuries,and 51 cases of fall injuries.According to the treatment methods,37 cases were treated with PFNA as the control group,and 49 cases were treated with cement combined with long-stem artificial femoral head replacement as the observation group.The general conditions of operation,SF-36 score of quality of life and health status,Harris score of hip function at different time points after operation and complications were compared between the two groups.Results The operation time,incision length and intraoperative bleeding volume of the control group were(68.57±13.78)min,(6.54±1.08)cm,(135.82±33.59)mL,respectively,which were better than those of the observation group(96.25±17.84)min,(10.25±1.36)cm,(187.93±40.26)mL(P<0.05).The postoperative landing time,complete weight-bearing time of affected limbs and hospitalization time of the observation group were(3.26±0.73)d,(4.13±0.87)d,(6.24±1.14)d,respectively,which were shorter than those of the control group(11.75±1.17)d,(43.68±6.54)d,(14.75±2.17)d(P<0.05).The Harris score of the observation group was higher than that of the control group at 1 month,3 months and 6 months after operation.The Harris score of two groups at 3 months after operation were higher than that of 1 month after operation,and that of two groups at 6 months after operation were higher than that of 3 months after operation(P<0.05).The Harris score of the control group at 12 months after operation was higher than that of 6 months after operation(P<0.05).The SF-36 scores of the observation group at 6 months after operation were higher than those of the control group(P<0.05).There were statistically significant differences in the SF-36 scores between two groups at different time points(P<0.05).The incidence of complications of the control group was 10.81%(4/37),compared with 10.20%(5/49)of the observation group,there was no significant difference(P>0.05).Conclusion The elderly patients with osteoporotic IFOF treated with PFNA has less surgical trauma,while cement combined with long-stem artificial femoral head replacement has faster recovery.