加长柄半髋关节置换治疗高龄不稳定型股骨粗隆间骨折效果观察

Efficacy of long-stem hemiarthroplasty for elderly unstable intertrochanteric fracture

目的探讨加长柄半髋关节置换术治疗高龄伴严重骨质疏松不稳定型股骨粗隆间骨折的临床效果。方法回顾性分析2017年4月至2019年4月聊城市人民医院48例高龄伴严重骨质疏松不稳定型股骨粗隆间骨折患者,23例采用加长柄半髋关节置换术(long-stem hemiarthroplasty,LHA)治疗(LHA组),25例采用股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)治疗(PFNA组)。将PFNA组作为对照组,通过比较两组患者手术时间,术中出血量,围手术期输血量,术中透视次数,术后下地负重时间,术后并发症发生率,住院时间及术后1、3、6、12个月复查时的Harris髋关节功能评分,探讨应用加长柄半髋关节置换术治疗高龄伴严重骨质疏松不稳定型股骨粗隆间骨折的效果评价。结果LHA组23例患者随访时间范围12.0~26.0个月,随访时间(18.6±3.9)个月;PFNA组25例患者随访时间范围12.0~24.0,随访时间(17.8±3.3)个月,两组随访时间比较差异无统计学意义(t=0.552,P=0.581)。LHA组患者手术时间[60(55,73)h]长于PFNA组[55(50,60)h],LHA组患者术中出血量[(179.35±63.47)mL]多于PFNA组[(122.80±49.03)mL],LHA组患者术中透视次数[2(2,2)次]少于PFNA组[16(15,20)次],LHA组患者开始下地负重时间[4(3,5)d]早于PFNA组[33(30,36)d],差异均有统计学意义(Z=2.459、t=3.470、Z=6.216、Z=5.959;P均<0.05)。两组患者围手术期输血量、住院时间、术后并发症发生率比较差异均无统计学意义(P均>0.05)。Harris髋关节功能评分术后1、3、6、12个月在LHA组[(76.70±5.96)、(82.13±6.38)、(85.96±7.16)、(88.78±7.67)分]和PFNA组[(63.80±3.46)、(71.56±2.55)、(81.60±3.38)、(88.08±4.83)分]均随着随访时间增长逐渐升高(F组内=432.557,P组内<0.001),术后12个月时评分达到最高。LHA组患者Harris髋关节功能评分高于PFNA组,差异有统计学意义(F组间=25.437,P组间<0.001)。随访时间点与手术方式之间存在交互效应(F交互=53.464,P交互<0.001)。结论对于高龄伴有重度骨质疏松的不稳定型股骨粗隆间骨折患者,选择应用加长柄半髋关节置换的手术方式,可早期下床负重,减少卧床并发症,减少术中透视次数,能更早且更好的恢复髋关节功能,效果满意。

Objective To investigate the clinical effect of long-stem hemiarthroplasty in the treatment of unstable intertrochanteric fracture in elderly patients with severe osteoporosis.Methods A retrospective analysis was performed on 48 elderly patients with unstable intertrochanteric fractures of the femur with severe osteoporosis in Liaocheng People′s Hospital from April 2017 to April 2019.Twenty three patients received long-stem hemiarthroplasty(LHA group).Twenty five patients were treated with proximal femoral nail anti-rotation(PFNA)(PFNA group).PFNA group was used as the control group.The operative time,intraoperative blood loss,perioperative blood transfusion volume,number of intraoperative fluoroscopy,weight-bearing time after operation,the incidence of postoperative complications,hospitalization time,and Harris hip score of 1,3,6,12 months after surgery,to investigate the efficacy of the application of long-stem hemiarthroplasty.Results In LHA group,23 patients were followed up for(18.6±3.9)(range from 12.0 to 26.0)months,and 25 patients in the PFNA group were followed up for(17.8±3.3)(range from 12.0 to 24.0)months.There was no significant difference in follow-up time between the two groups(Z=-0.552,P=0.581).The operation time of LHA Group(60(55,73)h)was longer than that of PFNA Group(55(50,60)h).The intraoperative blood loss in LHA Group((179.35±63.47)mL)was more than that in PFNA Group((122.80±49.03)mL).The number of fluoroscopy in LHA Group(2(2,2)times)was less than that in PFNA Group(16(14.5,19.5)times).The time of weight bearing in LHA Group(4(3,5)d)was earlier than that in PFNA Group(33(30,36)d),and the differences were statistically significant(Z=2.459,t=3.470,Z=6.216,Z=5.959;all P<0.05).There were no significant differences in perioperative blood transfusion,hospital stay and postoperative complications between the two groups(all P>0.05).Harris hip function score was significantly higher in LHA Group((76.70±5.96),(82.13±6.38),(85.96±7.16),(88.78±7.67)points)and PFNA Group((63.80±3.46),(71.56±2.55),(81.60±3.38),(88.08±4.83)points)increased gradually with the increase of follow-up time(Fintra-group=432.557,Pintra-group<0.001),and the score reached the highest 12 months after operation.Harris hip function score of LHA group was higher than that of PFNA group(Finter-group=25.437,Pinter-group<0.001).There was interaction effect between follow-up time point and operation mode(Finteraction=53.464,Pinteraction<0.001).Conclusion For the elderly patients with unstable intertrochanteric fracture with severe osteoporosis,the application of lengthened stem hemiarthroplasty can get out of bed early,reduce the complications of bed rest,reduce the number of intraoperative fluoroscopy,and recover the function of hip joint earlier and better with satisfactory results.