不稳定性老年股骨转子间骨折的术式选择对治疗结果的影响

Effect of operative method selection on treatment of unstable senile intertrochanteric fracture

目的探讨人工股骨头置换和闭合复位防旋股骨近端髓内钉(proximal femoral nail antirotation,PFNA)内固定术治疗老年不稳定型股骨转子间骨折的效果。方法 2017年3月-2018年2月冀中能源邢矿集团总医院收治80例不稳定性老年股骨转子间骨折患者,采用随机数字表法分为PFNA组40例,应用闭合复位PFNA内固定术治疗。男性26例,女性14例;年龄62~85岁,平均68. 8岁;致伤原因:摔伤29例,道路交通伤8例,高处坠落伤3例;骨折分型:II型20例,III型20例。置换术组40例,应用人工股骨头置换术治疗。男性25例,女性15例;年龄63~84岁,平均68. 7岁;致伤原因:摔伤30例,道路交通伤7例,高处坠落伤3例;骨折分型:II型21例,III型19例。术后平均随访半年,对两组患者手术相关指标(术中失血量、手术时间及术后下床活动时间)、术后并发症发生率、髋关节功能恢复优良率及髋关节功能评分进行比较。结果 PFNA组术中失血量、手术时间与术后下床活动时间少于置换术组(P <0. 05)。PFNA组相关并发症发生率(5. 00%)低于置换术组(22. 50%,P <0. 05);PFNA组髋关节功能恢复优良率(92. 50%)高于置换术组(75. 00%,P <0. 05);PFNA组术后6个月髋关节功能评分(84. 24±8. 61)分高于置换术组(79. 48±6. 32)分(P <0. 05)。结论不稳定性老年股骨转子间骨折患者实施闭合复位PFNA内固定术的治疗效果优于人工股骨头置换术,相关并发症的发生概率小,利于患者髋关节功能恢复。

Objective To investigate the clinical effects of the artificial femoral head replacement and the closed reduction with Proximal Femoral Nail Antirotation( PFNA) to treat the unstable elderly patients with intertrochanteric fracture of femur. Methods From Mar. 2017 to Feb. 2018,80 patients with unstable intertrochanteric fracture of femur in our hospital were randomly divided into observation group( 40 cases,treated by closed reduction and PFNA internal fixation) and control group( 40 cases treated by artificial femoral head replacement). In the observation group,there were 26 male cases and 14 female cases aged 62-85 years,with an average of 68. 8 years.Causes of injuries were: 29 cases of high falls,8 cases of road traffic injuries,and 3 cases of high fall injuries. Fracture classification included 20 cases of type II and 20 cases of type III. In the control group,there were 25 male cases and 15 female cases aged 63-84 years,with an average age of 68. 7 years. Causes of injuries were: 30 cases of falls,7 cases of road traffic injuries,and 3 cases of high fall injuries. Fracture classification included 21 cases of type II and 19 cases of type III. All patients were followed up for half a year. The indexes of operation( blood loss during operation,time of operation and time of getting out of bed after operation),incidence of postoperative complications,excellent and good rate of hip function recovery and the score of hip joint function were compared between the two groups. Results The amount of intraoperative blood loss during operation in the observation group was lower than that in the control group( P < 0. 05),and the operative time and the time of getting out of bed after operation were shorter than those in the control group( P < 0. 05),and the incidence of complications in the observation group( 5. 00%) was lower than that in the control group( 22. 50%,P <0. 05). The excellent and good rate of hip function recovery in the observation group( 92. 50%) was higher than that in the control group( 75. 00%,P < 0. 05),and the score of hip joint function in the observation group( 84. 24 ± 8. 61) was higher than that in the control group( 79. 48 ±6. 32,P <0. 05). Conclusion Closed reduction and PFNA internal fixation for unstable elderly patients with intertrochanteric fractures is more effective than artificial femoral head replacement. The incidence of complications is lower,and it is more helpful for the recovery of hip joint function in patients with unstable femoral intertrochanteric fractures.