股骨距替代髋关节置换术治疗老年股骨转子间骨折患者的疗效观察

Efficacy observation on hip arthroplasty with a calcar replacement femoral component in elderly patients with femoral intertrochanteric fracture

目的观察股骨距替代髋关节置换术治疗老年股骨转子间骨折患者的疗效。方法选取76例老年股骨转子间骨折患者,按照随机数字表法分为观察组和对照组,各38例。观察组采用股骨距替代型髋关节置换术治疗,对照组采用近端防旋髓内钉(PFNA)技术治疗。比较两组患者围术期指标、近期并发症发生率、围术期死亡率、术后2年随访情况及末次随访时髋关节功能、生活质量情况。结果观察组手术时间、术中出血量均高于对照组,术后住院时间、下床活动时间、近期并发症发生率均低于或短于对照组(均P<0.05),而两组患者围术期死亡率、骨性愈合时间、骨性愈合率及远期并发症发生率比较,差异均无统计学意义(均P>0.05)。末次随访时,两组患者髋关节Harris评分、生存质量SF-36量表评分及日常生活能力评分比较,差异均无统计学意义(均P>0.05)。结论股骨距替代髋关节置换术治疗老年股骨转子间骨折患者能够促进患者术后康复,减少近期并发症发生率,但术中对患者创伤较大,术中出血量较大,远期疗效与传统PFNA内固定术相当。

Objective To observe the curative effect of hip arthroplasty with a calcar replacement femoral component in the treatment of elderly patients with femoral intertrochanteric fracture.Methods Seventy-six elderly patients with femoral intertrochanteric fracture were selected,and were divided into observation group(n=38) and control group(n=38) by using random number table method.The observation group was treated with hip arthroplasty with a calcar replacement femoral component,and the control group with proximal femoral nail anti-rotation(PFNA).The perioperative indicators,the incidence of short-term complications,perioperative mortality,condition at the postoperative two-year follow-up,hip function at the last follow-up,and quality of life were compared between the two groups.Results Compared to the control group,the observation group obtained longer operation duration and greater intraoperative bleeding volume,shorter postoperative hospital stay and duration for ambulation,and a lower incidence rate of short-term complications(all P<0.05),whereas there were no statistically significant differences in the perioperative mortality,duration for osteonal union,osteonal union rate,and incidence rate of long-term complications between the patients in both groups(all P>0.05).At the last follow-up,no statistically significant differences were found between the patients in both groups in the Harris score of hip joint,score of SF-36 scale for quality of life,and score of activity of daily living(all P<0.05).Conclusion In the treatment of elderly patients with femoral intertrochanteric fracture,hip arthroplasty with a calcar replacement femoral component can facilitate postoperative rehabilitation of patients,and reduce the incidence rate of short-term complications;however,it can cause relatively great intraoperative trauma to the patients as well as more intraoperative bleeding volume,and achieves a long-term efficacy equivalent to the traditional internal fixation with PFNA.