PFNA内固定治疗术与髋关节置换术对老年股骨粗隆间骨折的临床疗效对比

Comparison of the clinical efficacy of PFNA internal fixation and hip replacement for intertrochanteric fractures in the elderly

目的:探讨防旋股骨近端髓内钉内固定治疗术(Proximal femoral screw internal fixation,PFNA)与人工髋关节置换术对股骨粗隆间骨折患者的影响。方法:选取我科2019年6月至2021年6月期间收治的121例老年股骨粗隆间骨折患者为研究对象,随机分为对照组和观察组,对照组(n=60)采用人工髋关节置换术治疗,观察组(n=61)采用PFNA治疗,在患者住院治疗期间记录并观察患者的手术时间、术中出血量、卧床时间、住院时间;在手术前及手术4 w后应用视觉模拟评分法(Visual analog scoring,VAS)和髋关节功能评分(Hip function score,Harris)量表观察患者的髋关节功能;在手术前及手术4 w后应用酶联免疫吸附法检测患者的血清骨保护素(Serum osteoprotectin,OPG)水平和血清碱性磷酸酶(Serum alkaline phosphatase,ALP)水平。结果:观察组患者的手术时间、术中出血量、卧床时间及住院时间均低于对照组(P<0.05);手术后观察组VAS评分低于对照组,Harris评分高于对照组(P<0.05),且观察组OPG、ALP水平高于对照组(P<0.05);两组出现术后并发症的人数对比无明显差异(P>0.05)。结论:PFNA内固定治疗术可提高患者的术后髋关节功能,改善患者血清ALP、OPG水平。

Objective:To investigate the effects of Proximal femoral screw internal fixation(PFNA)and artificial hip replacement on intertrochanteric fractures of femur.Methods:A total of 121 elderly patients with intertrochanteric fracture of femur in our department were selected as the research objects,and divided by random number method,60 patients in the control group were treated with artificial hip replacement,61 patients in the observation group were treated with PFNA.During hospitalization,the operation time,intraoperative blood loss,bed time and hospital stay were recorded and observed;Visual analog scoring(VAS)and Hip function score(Harris)were used to observe the Hip function of patients before and 4 weeks after surgery;the levels of Serum osteoprotectin(OPG)and Serum alkaline phosphatase(ALP)were detected by enzyme-linked immunosorbent assay(ELISA)before and 4 days after operation.Results:The operation time,intraoperative blood loss,bed time and hospital stay in the observation group were shorter than those in the control group(P<0.05).After operation,the visual simulation score of the observation group was lower than that of the control group,and the hip function score was higher than that of the control group(P<0.05).The levels of serum osteoprotectin and serum alkaline phosphatase in observation group were higher than those in control group(P<0.05).There was no significant difference in the number of postoperative complications between the two groups(P>0.05).Conclusion:PFNA internal fixation can improve postoperative hip function and serum ALP and OPG levels of patients.