高龄不稳定性股骨粗隆间骨折行直接前入路人工股骨头置换的临床疗效观察

Clinical observation of artificial femoral head replacement by direct anterior approach for unstable intertrochanteric fracture in the elderly

目的:探讨高龄不稳定性股骨粗隆间骨折行直接前入路(direct anterior approach,DAA)人工股骨头置换的临床疗效。方法:纳入2020年1月至2021年11月间诊治的40例年龄≥75岁的高龄不稳定性股骨粗隆间骨折患者。20例采用DAA人工股骨头置换术,20例采用股骨近端抗旋髓内钉(PFNA)内固定术。比较两组围手术期指标及日常生活能力(ADL)评分、髋关节Harris功能评分。结果:40例患者术后均遵医嘱定期随访,DAA组在初次下床活动时间明显少于PFNA组,术后日常生活能力ADL评分及髋关节功能Harris评分明显高于PFNA组,差异具有统计学意义(P<0.05)。PFNA组在手术时间、术中失血量、术后引流量方面更有优势(P<0.05)。结论:高龄不稳定性股骨粗隆间骨折行DAA人工股骨头置换的近期疗效显著。

Objective:To investigate the clinical effect of artificial femoral head replacement by direct anterior approach for unstable intertrochanteric fractures in the elderly.Methods:Forty elderly patients with unstable intertrochanteric fractures aged≥75 years were included in the diagnosis and treatment from January 2020 to November 2021.Direct anterior approach artificial femoral head replacement was performed in 20 cases,and proximal femoral anti-rotation intramedullary nail(PFNA)internal fixation was used in 20 cases.The perioperative indexes,activities of daily living(ADL)score and hip joint Harris function score were compared between the two groups.Results:40 patients(40 hips)were followed up regularly according to the doctor’s advice.The time of getting out of bed for the first time in the DAA group was significantly less than that in the PFNA group,and the postoperative ADL score of activities of daily living and Harris score of hip joint function were significantly higher(P<0.05).PFNA group had more advantages in operation time,intraoperative blood loss and postoperative drainage(P<0.05).Conclusion:DAA approach artificial femoral head replacement has a significant short-term effect in the treatment of unstable intertrochanteric fractures in the elderly.