全髋双动置换术与PFNA在治疗高龄股骨粗隆间骨折的临床疗效比较

Comparison on clinical curative effect of dual mobility total hip replacement and PFNA on intertrochanteric fractures in the elderly

目的探究全髋双动置换术与股骨近端髓内钉内固定(proximal femoral nail anti-rotation,PFNA)治疗高龄股骨粗隆间骨折的临床疗效。方法选择77例高龄股骨粗隆间骨折患者作为研究对象,32例患者行全髋双动置换术,纳入全髋双动置换术组,45例患者行PFNA手术治疗,纳入PFNA组。比较2组患者围手术期指标、疼痛评分、术后髋关节功能及并发症发生情况。结果全髋双动置换术组手术时间、下地负重时间及住院时间短于PFNA组,术中出血量高于PFNA组,差异有统计学意义(P<0.05);2组患者术后2周时疼痛评分差异无统计学意义(P>0.05),全髋双动置换术组患者术后3、6个月时疼痛评分显著低于PFNA组(P<0.05);末次随访时全髋双动置换术组患者Harris评分优于PFNA组(P<0.05);全髋双动置换术组、PFNA组髋关节功能恢复Harris评分等级比较差异有统计学意义(P<0.05)。结论全髋双动置换术治疗高龄股骨粗隆间骨折效果较好,与PFNA术比较,可缩短术后恢复时间,提高髋关节功能。

Objective To explore clinical curative effect of dual mobility total hip replacement(DMTHR)and proximal femoral nail anti-rotation(PFNA)on intertrochanteric fractures(IF)in the elderly.Methods Seventy-seven elderly IF patients who were admitted to the hospital were enrolled.Thirty-two patients underwent DMTHR(DMTHR group),while the other 45 patients underwent PFNA(PFNA group).Perioperative indexes,pain scores,postoperative hip function and occurrence of complications were compared between two groups.Results The operation time,weight-bearing time on the ground and hospitalization time in DMTHAPR group were shorter than those in PFNA group,while intraoperative blood loss was more than that in PFNA group(P<0.05).At 2 weeks after surgery,there was no significant difference in pain scores between two groups(P>0.05).At 3 and 6 months after surgery,pain scores in DMTHAPR group were significantly lower than those in PFNA group(P<0.05).At the last follow-up,Harris score of DMTHAPR group was better than that of PFNA group(P<0.05).There was a statistically significant difference in the Harris score between the total hip double-action replacement group and the PENA group(P<0.05).Conclusion The curative effect of DMTHAPR is relatively better on IF in the elderly.Compared with PFNA,it can shorten postoperative recovery time,and improve hip function.