人工股骨头置换术与股骨近端髓内钉内固定术治疗高龄股骨粗隆间粉碎性骨折患者的效果比较

Comparison of effects of artificial femoral head replacement and proximal femoral nail internal fixation in treatment of elderly patients with comminuted intertrochanteric fractures of femur

目的:比较人工股骨头置换术与股骨近端髓内钉(PFNA)内固定术治疗高龄股骨粗隆间粉碎性骨折患者的效果。方法:选取88例高龄股骨粗隆间粉碎性骨折患者为研究对象,按照随机数字表法分为研究组与对照组各44例。对照组行PFNA内固定术治疗,研究组予以人工股骨头置换术治疗,比较两组手术相关指标水平(手术时间、术中出血量、术中输血量、术后引流量、术后首次下地活动时间和术后住院时间)、并发症发生率及Harris评分。结果:研究组手术时间长于对照组,术后首次下地活动时间和术后住院时间短于对照组,术后引流量高于对照组,差异有统计学意义(P<0.05);研究组并发症发生率为6.82%,明显低于对照组的27.27%,差异有统计学意义(P<0.05);术后6、12个月,两组Harris评分均高于术前,且研究组明显高于对照组,差异有统计学意义(P<0.05);两组术中出血量、术中输血量比较,差异无统计学意义(P>0.05)。结论:人工股骨头置换术应用于高龄股骨粗隆间粉碎性骨折患者的效果优于PFNA内固定术,可缩短术后首次下地活动时间和术后住院时间,提高Harris评分,降低术后并发症发生率。但人工股骨头置换术手术时间长于PFNA内固定术,术后引流量高于PFNA内固定术。

Objective:To compare effects of artificial femoral head replacement and proximal femoral nail internal fixation(PFNA)in treatment of elderly patients with comminuted intertrochanteric fractures of femur.Methods:88 elderly patients with intertrochanteric comminuted fractures of femur were selected as the research objects,and were divided into study group and control group according to the random number table method,44 cases in each.The control group underwent PFNA internal fixation,while the study group underwent artificial femoral head replacement.The levels of surgery-related indicators(operation time,intraoperative blood loss,intraoperative blood transfusion volume,postoperative drainage volume,postoperative first out-of-bed activity time and the postoperative hospitalization time),the complication rate,and the Harris score were compared between the two groups.Results:The operation time of the study group was longer than that of the control group;the first out-of-bed activity time and the postoperative hospitalization time were shorter than those of the control group;the postoperative drainage volume was higher than that of the control group;and the differences were statistically significant(P<0.05).The incidence of complications in the study group was 6.82%,which was significantly lower than the control group of 27.27%,and the difference was statistically significant(P<0.05).6 and 12 months after the surgery,the Harris scores in both groups were higher than those before the surgery;that of the study group was significantly higher than that of the control group;and the differences were statistically significant(P<0.05).However,there were no significant differences in the intraoperative blood loss and the intraoperative blood transfusion volume between the two groups(P>0.05).Conclusions:Artificial femoral head replacement is more effective than PFNA internal fixation in the elderly patients with comminuted femoral intertrochanteric fractures of femur.It can shorten the time for the first out-of-bed activity time and the postoperative hospitalization time,improve the Harris score,and reduce the incidence of postoperative complications.However,the operation time of artificial femoral head replacement is longer than that of PFNA internal fixation,and the postoperative drainage volume is also higher.