生物型FHR与PFNA治疗高龄股骨粗隆间骨折疗效观察  

Proximal femoral nail anti-rotation versus biological artificial femoral head replacement for femoral intertro-chanteric fracture in the elderly

作　　者：周胜虎[1] 甄平[1] 李旭升[1] 沈伟伟[1] 刘军[1] 李生贵[1] 常彦峰[1] 

机构地区：[1]兰州军区兰州总医院骨科研究所关节外科,兰州730050

出　　处：《中国矫形外科杂志》2017年第6期487-491,共5页Orthopedic Journal of China

基　　金：甘肃省科技计划项目(编号:1208RJZA108);全军医药卫生基金课题(编号:CLZ12JAO7)

摘　　要：[目的]探讨生物型人工股骨头置换(femoral head replacement,FHR)与股骨近端抗旋转髓内钉(proximal femoral nail anti-rotation,PFNA)治疗高龄股骨粗隆间骨折的临床疗效。[方法]2008年3月~2012年12月对108例高龄粗隆间骨折患者实施手术治疗。男63例,女45例;平均年龄83.72岁(75~99岁)。所有患者术前常规行骨密度检测,骨折均行Evens-Jensen分型,随机分为生物型FHR组47例及PFNA组61例。比较两组患者手术时间、出血量、下床时间、住院时间、Harris评分及深静脉血栓、肺部及泌尿系感染等情况。[结果]所有患者术后均获12~36个月随访,平均(28.04±6.32)个月。平均手术时间:PFNA组(53.73±15.22)min,FHR组(77.50±16.83)min,差异有统计学意义(P<0.05)。平均术中出血量:PFNA组(132.51±33.21)ml,FHR组(286.34±43.23)ml,差异有统计学意义(P<0.05)。术后下床锻炼时间:PFNA组平均(12.24±3.72)d,FHR组平均(3.12±1.23)d,差异有统计学意义(P<0.05)。平均住院时间:PFNA组(7.60±1.83)d,FHR组(6.84±2.24)d,差异无统计学意义(P>0.05)。术后1年髋关节功能Harris评分:PFNA组(87.71±7.92)分,FHR组(88.31±9.21)分,差异无统计学意义(P>0.05)。术后并发症两组差异无统计学意义(P>0.05)。[结论]FHR与PFNA是治疗高龄股骨粗隆间骨折安全有效的内固定方式,均可获得良好的髋关节功能,但应严格掌握手术适应证,合理选择最佳有效的手术方式。[Objectvie] To compare the clinical effects between femoral head replacement （FHR） and proximal femo- ral nail anti-rotation （PFNA） on femoral intertroehanteric fracture in the elderly. [Methods] From March 2008 to Decem- ber 2012, 108 cases of femoral intertrochanteric fracture in elderly patients were enrolled in this study. Patients included 63 males and 45 females, aged from 75 to 99 years with an average of 83.72 years. Before the surgery, the patients＇ bone mineral density were routinely measured and the fracture were classified by Evens-Jensen. According to the surgical method, all patients were divided into biological FHR group （47 cases） and PFNA group （61 cases） randomly. The relevant indicators revealing the surgery cutcomes, including operation time intraoperative bleeding, getting out-of-bed time, hospitalization time, Harris scores and postoperative complications were observed and compared between two groups. [Results] All patients were followed up for 12 to 36 months, with an average of 28.04±6.32 months. The operation time of PFNA group and FHR group were （53.73±15.22） rain and （77.50±16.83） min, respectively （P〈0.05） . The intraoperative bleeding were （132.51±33.21） mL and （286.34±43.23） mL, respectively （P〈0.05） . The getting out-of-bed time were was found in the postoperative complications （P〉 0.05） . [Conclusion] Both the PFNA and biological FHR are safe and effective method for femoral intertrochanteric fracture in elderly patients, with good clinical curative effects. The surgery should be strictly selected according to the actual situations of patients.

关 键 词：股骨粗隆间骨折 高龄 股骨近端抗旋转髓内钉 人工股骨头置换术 

分 类 号：R687.3[医药卫生—骨科学]