关节置换与内固定治疗高龄股骨粗隆间骨折的比较

Comparison of clinical outcomes of arthroplasty versus internal fixation for femoral intertrochanteric fracture in elderly

[目的]比较关节置换与内固定治疗高龄股骨粗隆间骨折的临床疗效。[方法]回顾性分析2017年7月—2018年12月行手术治疗的120例高龄股骨粗隆间骨折患者,其中,60例采用关节置换,60例采用股骨近端抗旋转髓内钉(proximal femoral nail anti-rotation,PFNA)内固定。比较两组术前、围手术期、随访及影像学资料。[结果]120例患者均顺利完成手术。固定组在手术时间、术中出血量、切口长度、术后引流量方面均优于置换组,而置换组在术中透视次数、住院时间方面显著优于固定组,差异均有统计学意义(P<0.05)。两组患者随访12-36个月,平均(20.01±6.76)个月。置换组术后下地行走时间及完全负重活动时间均明显早于固定组(P<0.05)。随时间推移,两组患者VAS评分显著减少(P<0.05),而Harris评分显著增加(P<0.05)。术后1个月,固定组VAS评分显著小于置换组(P<0.05),术后6个月和末次随访时,两组间VAS评分差异无统计学意义(P>0.05)。术后1个月和6个月时,置换组患者髋关节功能Harris评分均显著高于固定组(P<0.05)。末次随访时,两组间髋关节功能Harris评分差异无统计学意义(P>0.05)。[结论]关节置换及PFNA内固定两种方法治疗高龄股骨粗隆间骨折均可以取得满意的临床效果。个性化选择治疗方案是获得满意治疗效果的关键。

[Objective] To compare the clinical outcomes of hip arthroplasty(HA) versus internal fixation with proximal femoral nail anti-rotation(PFNA) for femoral intertrochanteric fractures in elderly. [Methods] A retrospective study was conducted on 120 elderly patients who underwent surgical treatment for femoral intertrochanteric fractures from July 2017 to December 2018. Of them, 60 patients received hip arthroplasty, while the remaining 60 patients underwent closed reduction and internal fixation with PFNA. The preoperative, follow-up and imaging data were compared between the two groups. [Results] All the 120 patients had operation performed smoothly. The PFNA group was significantly superior to the HA group in operation time, intraoperative blood loss, incision length and postoperative drainage volume, while the HA group was significantly superior to the PFNA group in terms of the number of intraoperative fluoroscopy and hospitalization time, in which the differences were statistically significant(P<0.05). Patients in both groups were followed up for 12 to 36 months, with an average of(20.01±6.76) months. The HA group resumed walking and full weight-bearing activity significantly earlier than the PFNA group(P<0.05). The VAS scores decreased significantly(P<0.05), while the Harris score was significantly increased in both groups over time(P<0.05). At 1 month after surgery, the VAS score was significantly lower in the PFNA group than that of the HA group, whereas which became not statistically significant between the two groups at 6 months after surgery and at the last follow-up(P>0.05). However,the Harris scores in the HA group were significantly higher than those in the PFNA group at 1 and 6 months after surgery with statistically significant differences between the two groups(P<0.05), whereas which turned to be not significantly different between the two groups at the last follow-up(P>0.05). [Conclusion] Both arthroplasty and PFNA internal fixation do achieve satisfactory clinical outcomes for treatment of intertrochanteric fracture in elderly. Strictly grasping the indications when choosing a treatment method in clinical practice, and making personalized treatment plan are the key to obtain a satisfactory treatment outcome.