两种方法治疗老年股骨转子间骨折的疗效比较

Comparison effect of two methods for treatment of femoral intertrochanteric fractures in the elderly

目的比较股骨近端防旋髓内钉(PFNA)与半髋关节置换(HA)治疗老年股骨转子间骨折的临床疗效。方法将106例老年股骨转子间骨折患者根据治疗方法不同分为PFNA组(采用PFNA治疗,64例)和HA组(采用HA治疗,42例)。记录手术时间、术中出血量、术中透视次数、住院时间、住院费用、部分负重时间及并发症发生情况,采用Harris评分评价髋关节功能。结果患者均获得随访,时间12~24个月。手术时间、术中出血量、住院费用PFNA组短(少)于HA组(P<0.05)。术中透视次数PFNA组多于HA组(P<0.05)。部分负重时间HA组早于PFNA组(P<0.05)。住院时间两组比较差异无统计学意义(P>0.05)。髋关节功能Harris评分术后1、3、6个月HA组均高于PFNA组(P<0.05);术后12个月两组比较差异无统计学意义(P>0.05)。并发症发生率HA组低于PFNA组(P<0.05)。结论与PFNA相比,HA治疗老年股骨转子间骨折在早期髋关节功能改善和减少术后并发症方面更有优势,但存在手术时间长、术中出血量大、住院费用高等缺点。

Objective To compare the clinical efficacy of proximal femoral nail antirotation(PFNA)and hemiarthroplasty(HA)in the treatment of elderly femoral intertrochanteric fracture.Methods The 106 elderly patients with femoral intertrochanteric fractures were divided into PFNA group(64 cases)and HA group(42 cases),according to different treatment methods.Operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,hospital stay,hospital cost,partial weight-bearing time and complications were recorded.Harris score was used to evaluate hip joint function.Results All patients were followed up for 12~24 months.Operation time,intraoperative blood loss and hospitalization cost were shorter(less)in PFNA group than those in HA group(P<0.05).The frequency of intraoperative fluoroscopy in PFNA group was more than that in HA group(P<0.05).Partial weight-bearing time in HA group was earlier than that in PFNA group(P<0.05).There was no statistical difference in hospital stay between the two groups(P>0.05).The Harris score of hip function:HA group was higher than PFNA group at 1,3 and 6 months after operation(P<0.05);while there was no statistical difference between the two groups at 12 months after surgery(P>0.05).The complication occurrence rate of HA group was lower than PFNA group(P<0.05).Conclusions Compared with PFNA,HA has more advantages in the early improvement of hip function and the reduction of postoperative complications,in the treatment of elderly intertrochanteric fracture,but it has the disadvantages of long operation time,more intraoperative blood loss and high hospitalization cost.