PFNA内固定术与人工股骨头置换术治疗高龄股骨粗隆间骨折的效果对比

Comparison of the efficacy of PFNA internal fixation and artificial femoral head replacement in the treatment of intertrochanteric fracture of femur in the elderly

目的研究高龄股骨粗隆间骨折采用股骨近端防旋髓内钉(PFNA)内固定术与人工股骨头置换术治疗的效果。方法79例高龄股骨粗隆间骨折患者,随机分为对照组(39例,行PFNA内固定术治疗)和观察组(40例,行人工股骨头置换术治疗)。比较两组临床相关指标、临床并发症发生情况、关节功能、生活质量评分及治疗满意度。结果观察组住院时间(16.38±2.11)d、手术时间(53.65±7.15)min、下床活动时间(14.38±3.54)d明显短于对照组的(26.17±3.85)d、(65.35±8.35)min、(25.36±4.15)d,术中出血量(31.69±6.27)ml少于对照组(63.24±11.58)ml(P<0.05)。观察组并发症发生率7.50%低于对照组的33.33%(P<0.05)。观察组关节活动度、疼痛、功能、畸形评分及Harris总分分别为(19.93±3.51)、(18.69±3.14)、(20.76±3.84)、(19.58±3.85)、(78.96±3.85)分,明显高于对照组的(15.39±4.17)、(16.38±3.66)、(18.54±2.11)、(17.61±2.18)、(67.92±3.17)分(P<0.05)。观察组生理机能、躯体疼痛、社会功能、心理状态、情感职能、精神健康、活力、总体健康状态评分分别为(74.16±5.82)、(73.56±6.32)、(71.96±5.74)、(71.54±5.96)、(73.69±7.38)、(73.79±7.19)、(74.37±7.86)、(73.96±6.73)分,明显高于对照组的(57.68±3.57)、(59.81±3.65)、(56.74±3.75)、(55.17±4.15)、(56.85±4.85)、(58.13±4.57)、(56.85±5.11)、(57.19±5.32)分(P<0.05)。观察组总满意度97.50%高于对照组的74.36%(P<0.05)。结论与PFNA内固定术治疗相比较,人工股骨头置换术治疗高龄股骨粗隆间骨折效果及临床各项指标更优,并发症更少,具有较高的应用安全性,且更利于患者机体恢复,临床满意度较高。

Objective To study the effect of proximal femoral nail anti-rotation(PFNA)internal fixation and artificial femoral head replacement in the treatment of intertrochanteric fracture of femur in the elderly.Methods 79 elderly patients with intertrochanteric fracture of femur were randomly divided into a control group(39 cases,PFNA internal fixation)and an observation group(40 cases,artificial femoral head replacement).The clinical indicators,clinical complications,joint function,quality of life score and treatment satisfaction were compared between the two groups.Results In the observation group,the hospitalization time was(16.38±2.11)d,the operation time was(53.65±7.15)min and the off-bed ambulation time was(14.38±3.54)d,which were significantly shorter than(26.17±3.85)d,(65.35±8.35)min and(25.36±4.15)d in the control group;the intraoperative blood loss of(31.69±6.27)ml in the observation group was less than(63.24±11.58)ml in the control group(P<0.05).The complication rate of 7.50%in the observation group was lower than 33.33%in the control group(P<0.05).In the observation group,the joint range of motion,pain,function,deformity scores and total Harris score were(19.93±3.51),(18.69±3.14),(20.76±3.84),(19.58±3.85)and(78.96±3.85)points,which were significantly higher than(15.39±4.17),(16.38±3.66),(18.54±2.11),(17.61±2.18)and(67.92±3.17)points in the control group(P<0.05).The scores of physiological functioning,bodily pain,social functioning,mental state,role-emotional,mental health,vitality and general health in the observation group were(74.16±5.82),(73.56±6.32),(71.96±5.74),(71.54±5.96),(73.69±7.38),(73.79±7.19),(74.37±7.86)and(73.96±6.73)points,which were significantly higher than(57.68±3.57),(59.81±3.65),(56.74±3.75),(55.17±4.15),(56.85±4.85),(58.13±4.57),(56.85±5.11)and(57.19±5.32)points in the control group(P<0.05).The total satisfaction of 97.50%in the observation group was higher than 74.36%in the control group(P<0.05).Conclusion Compared with PFNA internal fixation,artificial femoral head replacement in the treatment of intertrochanteric fracture of femur in the elderly has better results and clinical indicators,fewer complications,higher application safety,and more conducive to patient recovery,with higher clinical satisfaction.