带股骨距假体置换与髓内钉治疗高龄股骨转子间骨折的临床疗效对比

Comparison of clinical efficacy of femoral calcar prosthesis replacement and intramedullary nail in the treatment of elderly patients with intertrochanteric fracture

目的:分析采用带股骨距假体髋关节置换术与同期行闭合复位防旋股骨近端髓内钉(proximal femoral nail antirotation,PFNA)内固定术治疗高龄患者(≥80岁)股骨转子间不稳定型骨折(EvansⅢ、Ⅳ型)的临床疗效。方法:回顾分析2016年6月至2018年3月采用假体置换与PFNA治疗的高龄股骨转子间不稳定型骨折患者60例,根据手术方式分为PFNA组与假体组,其中PFNA组男21例,女15例,年龄(84.3±2.9)岁;假体组男10例,女14例,年龄(82.9±2.4)岁。观察比较两组手术时间、术前与术后1 d血红蛋白差值、术后下地活动时间、住院时间及并发症发生情况,术后3、12个月行髋关节功能Harris评分。结果:患者均获得随访,时间12~24(19.3±4.8)个月,假体组1例1年后死于肺癌,随访终止。假体组手术时间长于PFNA组(P<0.05);术前后血红蛋白差值,假体组与PFNA组无差异(P>0.05);下地活动时间,假体组早于PFNA组(P<0.05);并发症出现数量,假体组少于PFNA组(P<0.05);治疗前假体组与PFNA组Harris评分差异无统计学意义,治疗后两组评分均较治疗前显著升高(P<0.05),术后3个月随访假体组评分高于髓内钉组(P<0.05),术后12个月差异无统计学意义(P>0.05)。结论:对高龄不稳定型股骨转子间骨折,尤其骨质疏松严重者,实施带股骨距假体髋关节置换术治疗是一种良好选择,有利于高龄患者术后功能锻炼和早期下地活动,减少并发症,提高生活质量,减轻家属及社会负担。

Objective:To analyze the clinical efficacy of hip arthroplasty with femoral calcar prosthesis and proximal femoral nail fixation(PFNA)in the treatment of elderly patients(≥80 years old)with unstable intertrochanteric fractures(EvansⅢ,Ⅳ).Methods:From June 2016 to March 2018,60 elderly patients with unstable intertrochanteric fractures treated with prosthetic replacement and PFNA were retrospectively analyzed.According to the surgical methods,they were divided into PFNA group and prosthesis group.In PFNA group there were including 21 males and 15 females,with an average age of(84.3±2.9)years old;in the prosthetic group,there were 10 males and 14 females with an average age of(82.9±2.4)years old.The operation time,hemoglobin difference between preoperative and postoperative 1 day,postoperative ambulation time,hospitalization time and complications were observed and compared between the two groups.Harris hip score was performed 3 and 12 months after operation.Results:All patients were followed up for 12 to 24 months(19.3±4.8)months.One patient in the prosthesis group died of lung cancer one year later and the follow-up was terminated.The operation time of prosthetic group was longer than that of PFNA group(P<0.05);hemoglobin difference before and after operation had no difference between prosthetic group and PFNA group(P>0.05);the time of ambulation in prosthetic group was earlier than that in PFNA group(P<0.05);the number of complications in prosthetic group was less than that in PFNA group(P<0.05);there was no significant difference in Harris score between prosthetic group and PFNA group before treatment,but scores of both groups were significantly increased after treatment(P<0.05).After 3 months of follow-up,the score of prosthesis group was higher than that of intramedullary nail group(P<0.05),but there was no significant difference at 12 months after operation(P>0.05).Conclusion:The elderly patients with intertrochanteric arthroplasty can reduce the burden of intertrochanteric arthroplasty and improve the quality of life.