PFNA与HA治疗高龄不稳定股骨粗隆间骨折的早期临床结果比较

Comparison of early clinical outcomes between proximal femoral nails antirotation and hemiarthroplasty for elderly unstable intertrochanteric fractures

目的探讨股骨近端防旋髓内钉(PFNA)与人工股骨头置换术(HA)治疗高龄不稳定股骨粗隆间骨折(IFF)的早期临床结果。方法选择2015年6月至2018年6月六安市人民医院骨科收治的高龄不稳定IFF患者86例,其中PFNA组46例,HA组40例。比较两组患者手术时间、术中出血量、术后下地时间,以及术后1、3、6、12个月的VAS评分、日常生活能力评定(ADL)Barthel指数、髋关节Harris评分及末次随访优良率、并发症发生率。结果PFNA组患者手术时间及术中出血量少于HA组,但术后下地时间晚于HA组,两组比较差异均有统计学意义(P<0.05);术后1、3个月VAS评分PFNA组高于HA组,术后1、3、6个月的Barthel指数、Harris评分HA组优于PFNA组,两组患者比较差异均有统计学意义(P<0.05)。PFNA组末次随访髋关节功能优良率为89.13%、HA组为87.50%,PFNA组并发症发生率为10.87%、HA组为5.00%,两组患者比较差异均无统计学意义(P=0.814、0.986)。结论PFNA及HA治疗高龄不稳定IFF均可取得满意效果,PFNA手术时间更短、术中出血更少;HA术后患者可更早下地负重活动、疼痛轻、生活质量高,近期效果更好。

Objective To investigate the early clinical routcomes of proximal femoral nails antirotation(PFNA)and hemiarthroplasty(HA)in the treatment of elderly unstable intertrochanteric fracture of femur(IFF).Methods Eighty-six elderly patients with unstable IFF in the Lu′an Municipal People′s Hospital from Jun.2015 to Jun.2018 were selected,including 46 cases in the PFNA group and 40 cases in the HA group.Followed up lasted for 12 months.The operative time,intraoperative blood loss volume,postoperative weight-bearing time,VAS scores in postoperative 1,3,6 and 12 months,ADL Barthel index,Harris hip score and excellent and good rate of hip function at the last follow-up,postoperative complication occurrence rate were compared between the two groups.Results The operation time and intraoperative blood loss volume in the PFNA group were less than those in the HA group,but the postoperative ambulation time on ground was later than that in the HA group,the differences between the two groups were statistically significant(P<0.05).The VAS score in postoperative 1,3 months in the PENA group were higher than those in the HA group;the Barthelindex and Harris hip score in the postoperative 1,3,6 months in the HA group were superior to those in the PFNA group,the differences between the two groups were statistically significant(P<0.05).The excellent and good rate of hip function at the last follow-up in the PFNA group was 89.13%,which in the HA group was 87.50%;the occurrence rate of postperative complications was 10.89%in the PFNA group and 5.00%in the HA group,the difference was not statistically significant(P=0.986).Conclusion Both PFNA and HA for treating elderly unstable IFF can achieve satisfactory effects,PFNA has shorter operation time and less intraoperative blood loss;the patients with HA can conduct earlier weight-bearing activities with light pain,high quality of life and good short term effect.