伤后不同时间行PFNA术对股骨转子间骨折老年病人预后的影响

Effect of PFNA on the prognosis of elderly patients with intertrochanteric fracture at different time after injury

目的:探讨伤后不同时间行闭合复位股骨近端防旋髓内钉内固定(PFNA)治疗对股骨转子间骨折老年病人预后的影响。方法:回顾性分析行PFNA术的142例股骨转子间骨折老年病人临床资料,根据骨折至手术时间分为早期组(骨折48 h内手术)和择期组(骨折48 h后手术),术后随访1年,比较2组骨折愈合时间、并发症、临床疗效及预后。结果:早期组住院时间短于择期组(P<0.05);住院期间早期组并发症发生率低于择期组(P<0.01);早期组远期病死率低于择期组(P<0.05)。2组病人在骨折临床愈合时间、近期病死率、末次随访髋关节功能方面的差异均无统计学意义(P>0.05)。结论:与择期PFNA手术相比,早期手术能够降低住院期间并发症风险、缩短住院时间、降低远期病死率,对老年髋部骨折的规范化治疗具有积极影响,评估一般状态良好的病人应首选早期手术。

Objective:To investigate the effects of the proximal femoral nail antirotation(PFNA)on prognosis of elderly patients with intertrochanteric fracture at different time after injury.Methods:The clinical data of 142 intertrochanteric fracture patients treated with PFNA were retrospectively analyzed.According to the time from fracture to operation,the patients were divided into the early group(operation within 48 hours after fracture)and elective group(operation after 48 hours of fracture),and followed up for 1 year.The fracture healing time,complications,clinical efficacy and prognosis were compared between the two groups.Results:The hospital stay in early group was shorter than that in elective group(P<0.05),the incidence rate of complications in early group during hospitalization was significantly lower than that in elective group(P<0.01),and the long-term mortality rate in early group was lower than that in elective group(P<0.05).There was no significant difference in clinical healing time,short-term mortality and hip joint function at last following up between the two groups(P>0.05).Conclusions:Compared with the elective PFNA surgery,the early surgery can reduce the risk of complications during hospitalization,shorten the length of hospital stay,and reduce the long-term mortality,which has a positive impact on the standardized treatment of elderly hip fracture.Early surgery should be the first choice for patients with good general condition.