双极人工股骨头与PFNA在不稳定型股骨粗隆间骨折的疗效评析  

Comparison between bipolar hemiarthroplasty and proximal femoral nail antirotation fixation for treatment of unstable intertrochanteric fractures in elderly patients

作　　者：王传学 杜秀藩[2] 

机构地区：[1]广州市白云区三元里街社区卫生服务中心,510405 [2]海南省农垦三亚医院骨科,572000

出　　处：《中华关节外科杂志（电子版）》2014年第4期60-63,共4页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的评价双极人工股骨头置换与股骨近端防旋髓内针（PFNA）内固定治疗高龄骨质疏松性股骨粗隆间骨折的临床疗效,探讨其合理的治疗方法。方法回顾性分析2009年1月~2013年9月期间,在农垦三亚医院采用双极人工股骨头置换（32例）与PFNA内固定治疗（43例）共75例70岁以上的股骨粗隆间骨折患者。骨折根据AO/OTA系统分型：转子间二部分骨折分为A1型（稳定骨折）,多部分骨折为A2型（不稳定骨折）,反斜形转子间骨折为A3型（不稳定骨折）。比较2组在手术时间、出血量、术后卧床时间、并发症发生率及术后1年病死率、Harris功能评分、人工关节松动率、住院时间等方面的指标。结果 75例均获得16~24个月随访,43例PFNA组骨折均顺利愈合;32例半髋关节置换假体无脱位、假体柄无明显下沉。两组术后髋关节功能优良率、内置物并发症差异不明显（P〉0.05）,但半髋关节置换组内科并发症更少（P〈0.05）、切口长度较大（P〈0.05）、手术时间较长（P〈0.05）、术中出血量较多（P〈0.05）、术后卧床时间及下地时间较短（P〈0.05）。结论双极人工股骨头置换术和PFNA内固定术均是治疗高龄患者粗隆间不稳定骨折的有效方法。双极人工股骨头治疗高龄伴严重骨质疏松的不稳定型股骨粗隆间骨折,下床活动早、早期并发症发生率低、功能恢复满意,可明显提高患者的生活质量。Objective To discuss a reasonable treatment for unstable intertrochanteric fractures in the elderly patients by comparing the effects of the bipolar hemiarthroplasty and the proximal femoral nail antirotation （ PFNA） fixation.Methods 75 cases of the intertrochanteric fractures in the elderly patients with complete clinical data were retrospectively analyzed .All these patients were treated with cement bipolar hemiarthroplasty or PFNA fixation from January 2009 to September 2013.32 cases were treated with cement bipolar hemiarthroplasty , 43 cases were treated with PFNA fixation . According to AO/OTA classification, all of them belonged to unstable fracture .Comparison was made between the two treated groups in terms of the hospital stays , the length of the incision , the blood loss during the surgery , the duration of the surgical procedure , the time for bed rest postoperatively , the postoperative complications and Harris hip score which were recorded for two years after the surgery .Results The follow -up duration were 16 -24 months.Compared with the PFNA fixation group , the hemiarthroplasty group experienced shorter time of the hospital stay and the bed rest postoperatively , and had longer incision length, longer operation time , and more blood loss during the surgery .The differences between the two groups were statistically significant （ P 〈0.05 ） .The difference in the postoperative internal medicine complications was significant （ P 〈0.05 ） .The differences in the postoperative implant complications and Harris hip score two years after the surgery between the two groups were not statistically significant （ P〉0.05 ） . Conclusions Both of the two methods are proper treatment methods for the unstable intertrochanteric fractures in the senile patients .Cement bipolar hemiarthroplasty has advantages of allowing early full weight bearing after the surgery , low complication rate and satisfactory functional recovery for unstable intertrochanteric hip fractures in the senile patients who

关 键 词：关节成形术 置换 股骨骨折 骨质疏松 

分 类 号：R687.3[医药卫生—骨科学]