半髋关节置换、动力加压钢板内固定及PFN治疗高龄老年不稳定型股骨粗隆间骨折的效果

Efficacies of hemi hip replacement,DHS and PFN in the treatment of unstable intertrochanteric femoral fractures in the elderly

目的探讨半髋关节置换、动力加压钢板内固定(DHS)以及PFN治疗高龄老年不稳定型股骨粗隆间骨折的临床效果。方法选取2018年1月至2020年1月荆州市第三人民医院收治的90例手术患者为研究对象,并以随机、平均的原则将其分成三组,第一组为置换组,实施半髋关节置换术治疗,第二组为DHS组,应用DHS术治疗,第三组为PFN组,采用PFN术治疗,比较三组手术时间、患肢负重时间、术中出血量、骨折愈合时间、术后引流量、术后3个月髋关节功能Harris评分以及并发症发生率。结果DHS组的手术时间、患肢负重时间、术中出血量、骨折愈合时间、术后引流量均长(高)于置换组和PFN组,差异有统计学意义(P<0.05),且置换组的手术时间、患者负重时间、骨折愈合时间均短(少)于PFN组,而置换组的术中出血量以及术后引流量多于PFN组,差异有统计学意义(P<0.05);DHS组术后3个月Harris评分高于置换组和PFN组,置换组的术后3个月Harris评分高于PFN组,差异有统计学意义(P<0.05);置换组的并发症总发生率为6.67%,低于DHS组(23.33%)和PFN组(26.67%),差异有统计学意义(P<0.05),但DHS组与PFN组在并发症发生率方面比较,差异无统计学意义(P>0.05)。结论在对高龄老年不稳定型股骨粗隆间骨折进行治疗过程中,三种术式各有优缺点,应结合临床实际情况及患者手术适应证来合理选择术式,以提升治疗效果。

Objective To investigate the clinical efficacies of hemi hip replacement,dynamic hip screw(DHS)and proximal femoral nail(PFN)in the treatment of unstable intertrochanteric femoral fractures in the elderly.Methods A total of 90 postoperative patients admitted to the Third People's Hospital of Jingzhou City from January 2018 to January 2020 were selected as the study objects.They were divided into three groups by the principle of randomization and averaging.The first group was the replacement group which was treated with hemi hip replacement.The second group was the DHS group which was treated with DHS.And the third group was the PFN group which was treated with PFN.The operation duration,weight-bearing duration of the affected limb,intraoperative blood loss,fracture healing duration,postoperative drainage,Harris scores of hip function at 3 months after operation,and the incidence of complications were compared among the three groups.Results The operation duration,weight-bearing duration of the affected limb,intraoperative blood loss,fracture healing duration,and postoperative drainage in the DHS group were longer(higher)than those in the replacement group and the PFN group,with statistically significant differences(P<0.05).The operation duration,weight-bearing duration,and fracture healing duration in the replacement group were shorter(less)than those in the PFN group,while the intraoperative blood loss and postoperative drainage in the replacement group were more than those in the PFN group,with statistically significant differences(P<0.05).The Harris scores at 3 months after operation were higher in the DHS group than those in the replacement group and the PFN group,and the Harris scores at 3 months after operation in the replacement group were higher than those in the PFN group,with statistically significant differences(P<0.05).The total incidence of complications in the replacement group was 6.67%,which was lower than that in the DHS group(23.33%)and that in the PFN group(26.67%),with statistically significant differences(P<0.05).However,there was no statistically significant difference between the DHS group and the PFN group in the incidence of complications(P>0.05).Conclusion In the treatment of unstable intertrochanteric femoral fractures in the elderly,the three operation methods mentioned above have their own advantages and disadvantages.Therefore,the operation method should be reasonably selected by taking into account the actual clinical situation and the operative indicat ions of patients to improve the efficacy.