人工股骨头置换术与股骨近端防旋髓内钉内固定治疗高龄不稳定性股骨转子间骨折的临床效果比较

Comparison of the clinical efficacy of artificial femoral head replacement and proximal femoral nail antirotation in the treatment of unstable intertrochanteric fractures of the femur in patients aged over 80 years old

目的比较人工股骨头置换术与股骨近端防旋髓内钉(PFNA)内固定治疗高龄不稳定性股骨转子间骨折的临床疗效。方法回顾性分析2016年1月至2018年6月南京江北人民医院骨科中心符合标准的98例高龄(≥80岁)股骨转子间骨折患者的临床资料,根据手术方式分为人工股骨头置换组和PFNA组,比较两组术中出血量、住院费用、完全负重时间、术后髋关节Harris功能评分及术后并发症等。结果PFNA组术中出血量、住院费用少于人工股骨头置换组,而完全负重时间长于人工股骨头置换组,差异有统计学意义(P<0.05);人工股骨头置换组术后1、3、6、12个月髋关节Harris评分优于PFNA组,差异有统计学意义(P<0.05);两组围手术期并发症发生率差异无统计学意义(P>0.05),但PFNA组并发症发生率高于人工股骨头置换组。结论人工股骨头置换术和PFNA内固定治疗高龄不稳定性股骨转子间骨折均具有较好疗效,但对于存在严重骨质疏松、合并多种内科疾病、术前评估可耐受且期望值较高的患者,人工股骨头置换术后可进行早期下床康复锻炼,降低术后并发症发生率,显著改善髋关节功能。

Objective To compare the efficacy of artificial femoral head replacement and proximal femoral nail antirotation(PFNA)for treatment of unstable intertrochanteric fractures of the femur in patients aged over 80 years old.Methods A retrospective study was conducted in 98 patients who were 80 years old or over suffering unstable intertrochanteric fractures of the femur in our department from January 2016 to June 2018.Based on surgical procedures,the patients were divided into the PFNA group and the artificial femoral head replacement group.The intraoperative blood loss,medical expenses in hospital,the full weight bearing time,the Harris scores and incidence of postoperative complications were compared between the two groups.Results The intraoperative blood loss and medical expenses in the PFNA group were less than those in the artificial femoral head replacement group,while the full weight bearing time was later than that in the artificial femoral head replacement group,with statistically significant difference(P<0.05).The Harris scores of the artificial femoral head replacement group were superior to the PFNA group at 1 month,3 months,6 months and 12 months postoperatively,all with statistically significant difference(all P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05),but the incidence in the PFNA group was higher than that in the artificial femoral head replacement group.Conclusion Both procedures could be used in the treatment of unstable intertrochanteric fracture of femur,but artificial femoral head replacement may be more suitable in patients with severe osteoporosis,high expectations and medical comorbidity precluding large surgical trauma,as it can start early rehabilitation postoperatively,reduce the incidence of complications and improve hip function and the quality of life.