水泥型假体半髋关节置换与PFNA治疗骨质疏松性不稳定股骨转子间骨折的疗效

Cemented prosthesis hemi-arthroplasty and PFNA in the treatment of elderly osteoporotic unstable femoral intertrochanteric fractures

目的探讨水泥型假体半髋关节置换治疗高龄骨质疏松性不稳定股骨转子间骨折临床疗效。方法选取 2016 年 1 月至 2018 年 1 月收治的 80 例高龄骨质疏松性股骨转子间骨折患者,按手术方式分为股骨近端防旋髓内钉 (proximal femoral nail anti-rotation,PFNA) 组 (40 例) 和半髋关节置换组 (40 例),比较两组手术时间、术中出血量、术后负重行走时间、住院时间以及髋关节功能 Harris 评分。结果所有患者均获平均 13.4 个月 (12~16 个月) 随访,两组的手术时间、术中出血量相比,PFNA 组明显优于半髋关节置换组[PFAN 组手术时间 (59.6±12.50) min,术中出血量 (198.5±80.7),半髋关节置换组手术时间 (71.8±8.20) min,术中出血量 (450.50±45.5) ml],两组相比差异有统计学意义 (P<0.05),住院时间、下地时间相比,水泥假体半髋关节置换组明显短于 PFNA 组[PFAN 组住院时间 (13.50±3.25) 天,下地时间 (46.6±3.5) 天;半髋关节置换组:住院时间 (10.25±2.30) 天,下地时间 (3.51±1.9) 天],两组相比差异有统计学意义 (P<0.05),水泥假体半髋关节置换组术后早期并发症发生率明显低于 PFNA 组,两组相比差异有统计学意义 (P<0.05),术后 1 个月、3 个月、6 个月 Harris 评分表明两组差异无统计学意义 (P>0.05),两种方法均能有效改善髋关节功能活动。结论采用水泥型假体半髋关节置换治疗高龄骨质疏松性不稳定股骨转子间骨折可显著缩短住院时间,早期下床负重行走,显著降低术后早期并发症发生率及病死率,显著提高患者日后生活质量,值得推广。

Objective To investigate the clinical efficacy of cemented prosthesis combined with hemi-arthroplasty for the treatment of elderly patients with osteoporotic unstable intertrochanteric fractures.Methods A selection of 80 elderly patients with osteoporotic unstable intertrochanteric fracture were analyzed from January 2016 to January 2018.All were divided into PFNA group (40 cases) and hemiarthroplasty group (40 cases).The operation time,intraoperative blood loss,postoperative weight-bearing walking,hospital stay and hip function were compared between the two groups.Results All patients were followed up for an average of 13.4 months (range:12-16 months).The PFNA group was significantly better than hemiarthroplasty group in operation time[(59.6±12.50) min,(71.8±8.20) min]and intraoperative blood loss[(198.5±80.7) ml,(450.50±45.5) ml](P<0.05).The hospital stay[(10.25±2.30) d,(13.50±3.25) d]and off-bed time[(3.51±1.9) d,(46.6±3.5) d]of the hemiarthroplasty group were significantly shorter than the PFNA group (P<0.05).Postoperative early complication rate was significantly lower in the hemiarthroplasty group (P<0.05).No significant differences in Harris score at 1 month,3 months,and 6 months after surgery were noted between the two groups (P>0.05).Both methods were effective to improve hip functions.Conclusions Cemented prosthesis hemi-arthroplasty will reduce hospital stay,complications and mortality,meanwhile facilitate early off-bed and improve the quality of life.