股骨头置换与髓内钉固定老年股骨粗隆间骨折比较

Hip hemiarthroplasty versus intramedullary nail fixation for femoral intertrochanteric fractures in elderlyy

[目的]比较股骨头置换与髓内钉固定治疗老年股骨粗隆间骨折的临床疗效。[方法]回顾性分析本院2015年8月—2020年8月128例老年股骨粗隆间骨折患者的临床资料,根据医患沟通结果,66例采用股骨头置换(置换组),62例采用髓内钉固定(固定组),比较两组围手术期、随访及影像结果。[结果]置换组的手术时间[(62.9±5.2)min vs(52.5±4.9)min,P<0.001]、切口总长度[(15.1±0.8)cm vs(12.2±0.8)cm,P<0.001]、术中失血量[(301.8±40.9)ml vs(142.9±20.2)ml,P<0.001]、住院时间[(13.7±1.1)d vs(12.6±1.5)d,P<0.001]均显著多于固定组,但术中透视次数[(3.5±1.1)次vs(13.8±2.1)次,P<0.001]和下地行走时间[(3.4±1.3)d vs(18.0±4.6)d,P<0.001]显著少于固定组。置换组的完全负重时间[(24.0±2.0)d vs(59.4±2.6)d,P<0.001]显著早于固定组。随时间推移,两组VAS评分、Harris评分均显著改善(P<0.05),术后相应时间点置换组VAS评分显著优于固定组(P<0.05);置换组术后1、3个月的Harris评分显著优于固定组(P<0.05)。影像方面,与术前相比,末次随访时,置换组双侧肢长差显著减小;与术后即刻相比,末次随访时固定组颈干角(femoral neck shaft angle,FNSA)显著减小(P<0.05),顶尖距(tip-apex distance,TAD)显著增加(P<0.05)。[结论]对于老年股骨粗隆间骨折,髓内钉内固定和股骨头置换均可取得较好疗效,相比较而言,只要术前患者本身条件许可,股骨头置换更具有优势。

[Objective]To compare the clinical outcomes of hip hemiarthroplasty versus internal fixation with proximal femoral nail an-ti-rotation(PFNA)for femoral intertrochanteric fractures in the elderly.[Methods]A retrospective study was conducted on 128 elderly pa-tients who received surgical treatment for femoral intertrochanteric fractures in our hospital from August 2015 to August 2020.According to the preoperative doctor-patient communication,66 patients received hip hemiarthroplasty(the hemiarthroplasty group),while other 62 pa-tients received PFNA fixation(the PFNA group).The documents regarding to perioperative period,follow-up and images were compared be-tween the two groups.[Results]Although the hemiarthroplasty group proved significantly greater than the PFNA group in terms of operative time[(62.9±5.2)min us(52.5±4.9)min,P<0.001],total incision length[(15.1±0.8)cm us(12.2±0.8)cm,P<0.001],intraoperative blood loss[(301.8±40.9)ml us(142.9±20.2)ml,P<0.001],and length of hospital stay[(13.7±1.1)days vs(12.6±1.5)days,P<0.001],the former was significantly better than the latter in intraoperative fluoroscopy times[(3.5±1.1)times us(13.8±2.1)times,P<0.001]and the ambulation time[(3.4±1.3)days us(18.0±4.6)days,P<0.001].In addition,the hemiarthroplasty group regained full weight bearing activity significantly earlier than the PFNA group[(24.0±2.0)days vs(59.4±2.6)days,P<0.001].The VAS score and Harris score significantly improved in both groups over time(P<0.05),and the hemiarthroplasty group was significantly superior to the PFNA group in terms of VAS score at all time point after surgery(P<0.05),and Harris scores at 1 and 3 months after operation(P<0.05).With respect of imaging,the leg length discrep-ancy in the hemiarthroplasty group significantly reduced at the last follow-up compared with that before surgery.On other hand,the femoral neck shaft angle(FNSA)significantly decreased(P<0.05),whereas the tip-apex distance(TAD)significantly increased in the PFNA group at the last follow-up compared with those immediately after operation(P<0.05).[Conclusion]Both hemiarthroplasty and PFNA fixation achieve satisfactory consequences for femoral intertrochanteric fractures in the elderly.In comparison,hemiarthroplasty is more advanta-geous as long as the patient's own conditions permit before surgery.