生物型人工股骨头置换术和PFNA内固定术治疗老年Evans Ⅲ Ⅳ型股骨转子间骨折效果对比

Comparison of the Effects between Biotype Artificial Femoral Head Replacement and PFNA Internal Fixation for the Treatment of Evans Ⅲ and Ⅳ Intertrochanteric Fractures in the Elderly

目的:探讨生物型人工股骨头置换术和防旋型股骨近端髓内钉(PFNA)内固定术治疗老年Evans Ⅲ、Ⅳ型股骨转子间骨折的临床效果。方法:选取2015年12月至2018年1月本院诊治的80例股骨转子间骨折患者为对象,根据非随机临床同期对照研究及患者自愿原则,将其分为对照组和观察组各40例,对照组行PFNA内固定术治疗,观察组行生物型人工股骨头置换术治疗,比较两组手术一般情况、临床疗效、髋关节功能恢复(采用Harris评分评估)情况及并发症发生情况。结果:观察组手术时间较对照组明显长,术中出血量较对照组多,而住院时间、术后下地时间较对照组明显短,治疗后观察组临床总有效率较对照组明显高(P<0.05);术前两组Harris评分相较无明显差异(P>0.05);术后1、3、6个月观察组Harris评分较对照组明显高(P<0.05);术后观察组并发症总发生率较对照组明显低(P<0.05)。结论:与PFNA内固定术相较,生物型人工股骨头置换术治疗老年Evans Ⅲ、Ⅳ型股骨转子间骨折患者在疗效、预后及安全性等方面更具优势。

Objective:To investigate the clinical effects of biotype artificial femoral head replacement and proximal femoral nail anti-rotation (PFNA) internal fixation in the treatment of elderly Evans III and IV intertrochanteric fractures. Methods: 80 patients with intertrochanteric fractures diagnosed in the hospital from December 2015 to January 2018 were selected as study subjects. They were divided into the control group and the observation group according to the non-randomized clinical concurrent control study and patient voluntary principle, 40 patients in each group. The control group was treated with PFNA internal fixation while the observation group was treated with Corail biotype artificial femoral head replacement. The general conditions of surgery, clinical curative effect, hip function recovery (evaluated by Harris score) and complications were compared between the two groups. Results: The surgical time of the observation group was significantly longer than that of the control group, and intraoperative blood loss was more than that of the control group, while length of hospital stay and postoperative ambulation time were significantly shorter than those of the control group. The clinical total response rate of the observation group was significantly higher than that of the control group after treatment (P<0.05). There was no significant difference in preoperative Harris score between the two groups (P>0.05). The Harris scores of observation group were significantly higher than those of the control group at 1 month, 3 months and 6 months after surgery (P<0.05). The total incidence of postoperative complications in the observation group was significantly lower than that in the control group (P<0.05). Conclusion: Compared with PFNA internal fixation, biological artificial femoral head replacement has more advantages in the treatment of elderly patients with Evans III and IV intertrochanteric fractures in terms of efficacy, prognosis and safety.