不同手术方式治疗老年髋部骨质疏松性骨折术后对侧髋部再骨折的风险及对策

Study on the risk and countermeasures of contralateral hip refracture after different surgical methods in the treatment of osteoporotic hip fracture in the elderly

目的:研究股骨近端防旋髓内钉(PFNA)与人工股骨头置换(FHR)治疗老年髋部骨质疏松性骨折术后对侧髋部再骨折发生的风险及对策。方法:回顾性分析71例75岁以上股骨粗隆间粉碎性骨折病人。按照手术方式分为PFNA组(52例)和FHR组(19例)。比较2组病人相关临床指标,术后不同时期髋关节Harris功能评分、对侧髋部骨密度及对侧髋部再发骨折发生率。结果:PFNA组手术切口长度、手术时间、术中出血量、住院时间及住院花费均小于FHR组,术后负重时间长于FHR组(P<0.05~P<0.01)。FHR组术后1、3个月Harris评分高于PFNA组(P<0.05),2组6、12个月Harris评分差异无统计学意义(P>0.05)。重复测量方差分析显示,2组术后对侧髋部骨密度变化时间因素及时间与手术方式的交互作用差异均有统计学意义(P<0.01)。同一时间2组比较,PFNA组术后对侧髋部骨密度变化均低于FHR组(P<0.05~P<0.01)。结论:PFNA和FHR术后病人均有较长时间处于低骨密度水平,应强调持续安全防护和骨质疏松性骨折后骨质疏松管理。FHR更有利于降低严重骨质疏松病人对侧髋部再骨折发生风险。

Objective:To study the risk and countermeasures of contralateral hip refracture after proximal femoral nail anti-rotation(PFNA)and artificial femoral head replacement(FHR)in the treatment of osteoporotic hip fracture in the elderly.Methods:The clnical data of 71 patients aged more than 75 years old with omminuted intertrochanteric fracture of the femur were retrospectively analyzed.The pateints were divided inton the PFNA group(52 cases)and FHR group(19 cases)according to the different surgical methods.The relative clinical indexes,Harris functional score of the hip joint at different postoperative stages,bone mineral density of the contralateral hip and incidence rate of refracture of the contralateral hip were compared between two groups.Results:The length of incision,operative time,intraoperative blood loss,length of hospital stay and hospitalization cost in PFNA group were less than those in FHR group,and the postoperative weight-bearing time in PFNA group was longer than that in FHR group(P<0.05 to P<0.01).The Harris scores in FHR group after 1 and 3 months of operation were higher than those in PFNA group(P<0.05),and there was no statistical significannce in the Harris scores between two groups after 6 and 12 months of surgery(P>0.05).The results of repeated ANOVA showed that the differences of the time of bone mineral density in contralateral hip change and interactions of surgical modalities between two groups were statistically significant after operation(P<0.01).Comparing two groups at the same time,the changes in the bone mineral density of the opposite hip bone after surgery in the PFNA group were lower than those in the FHR group(P<0.05 to P<0.01).Conclusions:The bone mineral density levels in postoperative patients treated with PFNA and FHR are low,the continuous safety protection and management of osteoporosis after osteoporotic fractures should be emphasized.FHR is more conducive to reduce the risk of refracture of the contralateral hip in patients with severe osteoporosis.