髓内固定系统与关节置换术治疗老年骨质疏松性股骨粗隆间骨折的效果比较

Comparison on Curative Effect of PFNA and Arthroplasty on Intertrochanteric Fractures in the Elderly

目的:探讨并比较髓内固定系统(PFNA)与关节置换术治疗老年人股骨粗隆间骨折患者的近期效果及对髋关节功能恢复的影响。方法:回顾性分析2015年5月至2017年5月本院收治的93例年龄≥60岁的老年骨质疏松性股骨粗隆间骨折患者病例资料,根据手术方案分为PFNA组(52例)和人工关节置换组(41例),观察两组手术情况、术后恢复情况及并发症发生率,术前及术后14 d、3个月进行Harris髋关节功能评估,检测两组术前及术后7 dⅠ型前胶原氨基端前肽(PINP)、β-胶原降解产物(β-CTx)、白介素-4(IL-4)、白介素6(IL-6)水平变化。结果:PFNA组术中出血量少于人工关节置换组,手术时间、下床活动时间、完全负重时间长于人工关节置换组,差异有统计学意义(P<0.05);PFNA组术后14 d、3个月Harris评分均低于人工关节置换组,差异有统计学意义(P<0.05);PFNA组术后7 d血清PINP水平高于人工关节置换组,血清β-CTx,IL-4及IL-6水平低于人工关节置换组,差异有统计学意义(P<0.05);两组术后并发症发生率比较差异无统计学意义(P>0.05)。结论:PFNA与关节置换术治疗老年骨质疏松性股骨粗隆间骨折各具优势,其中PFNA手术创伤小,术后短期内骨代谢指标及炎性因子水平改变明显,关节置换术有利于患者早期下床活动,术后短期关节功能恢复好。

Objective:To explore and compare short-term curative effect of proximal femoral nail anti-rotation(PFNA)and arthroplasty on elderly patients with intertrochanteric fractures and their influences on hip function recovery.Methods:A retrospective analysis was performed on case data of 93 elderly patients with osteoporotic intertrochanteric fractures aged not less than 60 years old who were admitted to the hospital from May 2015 to May 2017.According to different surgical plans,they were divided into PFNA group(52 cases)and arthroplasty group(41 cases).The operation status,postoperative recovery and incidence of complications in both groups were observed.Before surgery,at 14 d and 3 months after surgery,Harris hip function was applied to evaluate hip function.Before surgery and at 7 d after surgery,changes in levels of procollagen I N-terminal peptide(PINP),β-collagen degradation products(β-CTx),interleukin-4(IL-4)and interleukin-6(IL-6)in both groups were detected.Results:The intraoperative blood loss in PFNA group was less than that in arthroplasty group,while operation time,leaving bed time and full weight-bearing time were longer than those in arthroplasty group(P<0.05).At 14 d and 3 months after surgery,Harris score in PFNA group was lower than that in arthroplasty group(P<0.05).At 7 d after surgery,serum PINP level in PFNA group was higher than that in arthroplasty group,while levels of serumβ-CTx,IL-4 and IL-6 were lower than those in arthroplasty group(P<0.05).There was no significant difference in incidence of postoperative complications between the two groups(P>0.05).Conclusion:There are advantages of both PFNA and arthroplasty in treatment of elderly osteoporotic intertrochanteric fractures.The surgical trauma of PFNA is little,changes of bone metabolism indexes and inflammatory factors levels are significantly in the short term,while arthroplasty is beneficial to early leaving bed activity,short-term joint function recovery after surgery is good.