三种手术治疗股骨粗隆间骨折的临床疗效观察

Observation on the clinical effect of three kinds of operations for the treatment of femoral intertrochanteric fractures

目的比较股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)、锁定加压接骨板(locking compression plate,LCP)内固定以及髋关节置换术对股骨粗隆间骨折的治疗效果。方法选取2017年6月至2019年6月武汉科技大学附属华润武钢总医院收治的80例股骨粗隆间骨折患者,根据治疗方法的不同分为PFNA组(26例)、LCP组(25例)和关节置换组(29例),比较三组的手术时间、术中出血量、住院时间、下地负重时间、骨折愈合时间和髋关节功能Harris评分,以及术后1年内的并发症发生情况。结果PFNA组手术时间短于LCP组和关节置换组,差异有显著性(P<0.05);LCP组术中出血量少于PFNA组和关节置换组,且PFNA组少于关节置换组,差异有显著性(P<0.05);PFNA组住院时间短于LCP组和关节置换组,且LCP组短于关节置换组,差异有显著性(P<0.05);关节置换组下地负重时间短于PFNA组和LCP组,差异有显著性(P<0.05);关节置换组和PFNA组骨折愈合时间短于LCP组,差异有显著性(P<0.05)。术后三组髋关节功能Harris评分比较差异无显著性(P>0.05)。术后1年内关节置换组并发症发生率明显低于PFNA组和LCP组,差异有显著性(P<0.05),而PFNA组与LCP组比较差异无显著性(P>0.05)。结论PFNA、LCP内固定及髋关节置换术均是股骨粗隆间骨折的有效治疗方法,其中髋关节置换术具有术后卧床时间短、并发症发生率低等优势,但术中出血多、住院时间长,临床上应综合各种方法的优缺点进行合理选择。

Objective Compared the effects of proximal femoral anti-rotation intramedullary nail(PFNA),locking compression plate(LCP)internal fixation,and hip replacement on the treatment of femoral intertrochanteric fractures.Method Total of 80 patients with femoral intertrochanteric fractures admitted to our hospital from June 2017 to June 2019 were enrolled.The patients were divided into the PFNA group(n=26),the LCP group(n=25)and the joint group(n=29)according to the treatment method.The operation time,intraoperative blood loss,hospitalization time,down load time,fracture healing time and hip function score(Harris score)were compared between the three groups.The complications occurred in the three groups in 1 year follow-up was compared.Result The intraoperative blood loss of the LCP group was significantly less than that of the PFNA group and the joint group(P<0.05),and the blood loss of the PFNA group was significantly less than that of the joint group(P<0.05),the operation time of the PFNA group was significantly shorter than that of the LCP group and the joint group(P<0.05),the fracture healing time of joint group and PFNA group was significantly shorter than that of LCP group(P<0.05),the weight-bearing time under the joint group was significantly shorter than that of the PFNA group and LCP group(P<0.05),the length of stay in the PFNA group was significantly shorter than that of the LCP group and the joint group(P<0.05),and the LCP group was significantly shorter than the joint group(P<0.05);There was no significant difference in the Harris scores between the three groups(P>0.05).The incidence of complications in the joint group was significantly lower than that of PFNA group and LCP group(P<0.05).There was no significant difference between PFNA group and LCP group(P>0.05).Conclusion PFNA,LCP internal fixation and hip arthroplasty are effective methods for the treatment of intertrochanteric fractures.The hip arthroplasty has short bedtime and the incidence of symptoms is low,while more intraoperative blood loss and the time of hospital stay is long.In clinical practice,the advantages and disadvantages of various methods should be considered comprehensively.