微创股骨头置换术与股骨近端防旋髓内钉治疗高龄粉碎性股骨转子间骨折的疗效比较

Comparison of clinical effects of minimally invasive femoral head replacement and proximal femoral nail antirotation in the treatment of comminuted intertrochanteric fracture in the elderly

目的:探讨微创股骨头置换术与股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定术治疗高龄粉碎性股骨转子间骨折患者的临床疗效。方法:2020年4月至2020年10月治疗高龄粉碎性股骨转子间骨折患者76例,分别采用微创股骨头置换术(假体组)与PFNA内固定术。假体组35例,女24例,男11例,年龄(86.2±6.1)岁;PFNA组41例,女28例,男13例,年龄(84.6±5.3)岁。观察比较两组手术时间、术中出血量、术后下地活动时间、住院时间及并发症发生情况,术后1、6、12个月行髋关节功能Harris评分。结果:患者均获得随访,时间13~17(14.3±1.4)个月。假体组手术时间长于PFNA组(P<0.05);PFNA组出血量少于假体组(P<0.05);术后下地活动时间假体组明显早于PFNA组(P<0.05);术后1、6个月假体组的Harris评分高于PFNA组(P<0.05),术后12个月两组Harris评分比较,差异无统计学意义(P>0.05)。假体组并发症少于PFNA组(P<0.05)。结论:高龄粉碎性股骨转子间骨折患者,采用微创股骨头置换术治疗是一种良好选择,有利于术后早期康复,减少并发症,提高生活质量,减轻家属及社会负担。

Objective To analyze the clinical effect of minimally invasive femoral head replacement and proximal femoral nail antirotation(PFNA)internal fixation at the same time in the treatment of elderly patients with comminuted intertrochanteric fracture.Methods From April 2020 to October 2020,76 elderly patients with comminuted intertrochanteric fracture treated by minimally invasive femoral head replacement and PFNA were analyzed retrospectively.There were 35 patients in the prosthetic group,including 24 females and 11 males with an average age of(86.2±6.1)years old.There were 41 patients in PFNA group including 28 females and 13 males with an average age of(84.6±5.3)years old.The operation time,intraoperative blood loss,postoperative ambulation time,hospitalization time and complications were observed and compared between two groups.Harris hip score was performed at 1,6 and 12 months after operation.Results All patients were followed up for 13 to 17 months with an average of(14.3±1.4)months.The operation time of the prosthesis group was longer than that of the PFNA group(P<0.05);the amount of bleeding in PFNA group was less than that in prosthesis group(P>0.05);the time of ambulation in prosthetic group was earlier than that in PFNA group(P<0.05);the number of complications in the prosthesis group was less than that in the PFNA group(P<0.05);the Harris score of prosthesis group was significantly higher than that of PFNA group at 1 and 6 months after operation(P<0.05),but there was no significant difference in Harris score between two groups at 12 months after operation(P>0.05);the number of complications in the prosthesis group was less than that in the PFNA group(P<0.05).Conclusion Minimally invasive femoral head replacement is a good choice for the elderly patients with commuited intertrochanteric fracture.It can improve the quality of life and reduce the burden of family members and society.