人工股骨头置换术与股骨近端防旋髓内钉内固定术治疗老年粗隆间骨折的临床疗效分析

Clinical analysis of artificial femoral head replacement and proximal femoral nail antirotation internal fixation in the treatment of intertrochanteric fractures in the elderly

目的:探讨人工股骨头置换术(artificial femoral head replacement,AFHR)与股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定术治疗老年粗隆间骨折的临床疗效。方法:选取2015-01-01~2020-01-31我院关节外科收治的45例老年粗隆间骨折患者为研究对象。根据手术方式将其分为AFHR组(n=20)和PFNA内固定组(n=25)。比较两组的手术时间、术中出血量、术后卧床时间、术后并发症及髋关节Harris评分。结果:AFHR组的手术时间、术后卧床时间短于PFNA内固定组,术中出血量多于PFNA内固定组,差异均有显著统计学意义(P<0.01)。AFHR组的术后并发症发生率低于PFNA内固定组,但差异无统计学意义(P>0.05)。AFHR组术后1个月、3个月、6个月的髋关节Harris评分均高于PFNA内固定组,差异均有显著统计学意义(P<0.01)。结论:AFHR治疗老年股骨粗隆间骨折疗效显著,手术时间及术后卧床时间短,能较早地恢复患者行走能力,并有效降低术后并发症发生率,大大提高了老年患者的生活质量,值得临床推广应用。

Objective:To explore the clinical efficacy of artificial femoral head replacement(AFHR)and proximal femoral nail antirotation(PFNA)internal fixation in the treatment of intertrochanteric fractures in the elderly.Methods:Forty-five elderly patients with intertrochanteric fractures from 2015-01-01 to 2020-01-31 in our hospital as the research objects.According to the different surgical methods,they were divided into AFHR group(n=20)and PFNA internal fixation group(n=25).The operation time,intraoperative blood loss,postoperative bed time,postoperative complications and Harris score of hip joint between the two groups were compared.Results:The operation time and postoperative bed time of the AFHR group was less than that of the PFNA internal fixation group,the intraoperative blood loss was more than that of the PFNA internal fixation group,and the difference was statistically significant(P<0.01).The incidence of postoperative complications in the AFHR group was lower than that in the PFNA internal fixation group,and the difference was not statistically significant(P>0.05).The Harris scores of hip joint at 1,3,and 6 months after surgery in the AFHR group was higher than those in the PFNA internal fixation group,and the difference was statistically significant(P<0.01).Conclusion:AFHR surgery has a significant therapeutic effect in elderly patients with femoral intertrochanteric fractures.The operation time and postoperative bed time are short,which facilitate to restore the patient′s walking ability earlier and effectively reduce the incidence of postoperative complications.It greatly improves the quality of life in elderly patients,which is worthy of clinical application.