人工股骨头置换与股骨近端防旋髓内钉治疗老年股骨转子间骨折的疗效分析  

A clinical evaluation on the treatment of femoral intertrochanteric fracture in the elderly patients with hemiarthroplasty and PFNA

作　　者：吴德伟[1] 唐列[2] 

机构地区：[1]贵阳市第四人民医院骨一科,贵阳550002 [2]贵阳中医学院研究生院,贵阳550002

出　　处：《骨科》2017年第3期212-217,共6页ORTHOPAEDICS

摘　　要：目的评价人工股骨头置换与股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)治疗老年股骨转子间骨折的疗效及安全性。方法回顾性分析2012年1月至2015年1月于贵阳市第四人民医院采用人工股骨头置换术(股骨头置换组,31例)或PFNA(PFNA组,34例)治疗老年股骨转子间骨折病人的临床资料,比较两组病人的手术情况、住院期间疼痛情况、下地时间、骨折愈合时间、末次随访时的髋关节Harris评分及并发症情况。结果两组病人在住院期间均未发生术区切口感染。股骨头置换组的手术时间和术中出血量分别为(42.60±10.12)min、(129.38±70.20)ml,PFNA组分别为(76.71±30.47)min、(301.43±168.44)ml,差异均具有统计学意义(t=-47.37,P<0.0001;t=-41.41,P<0.0001);股骨头置换组术后第3天的疼痛视觉模拟量表(visual analogue scale,VAS)评分为(1.06±1.73)分,PFNA组为(0.94±1.61)分,差异无统计学意义;股骨头置换组的下地活动时间为(1.94±1.44)d,明显低于PFNA组的(5.50±1.64)d,差异具有统计学意义(t=-9.291,P<0.0001);股骨头置换组的骨折愈合时间为6~11周,末次随访时的髋关节Harris评分优良率为87.1%,PFNA组的骨折愈合时间为6~12周,末次随访时的Harris评分优良率为85.3%,差异无统计学意义(Z=-0.51,P=0.610)。股骨头置换组发生假体周围骨折1例,假体松动1例;PFNA组术后正常死亡3例,内植物感染2例,螺旋刀片松动3例,骨折不愈合1例。两组间的并发症发生率比较,差异无统计学意义(χ~2=1.972,P=0.160)。结论 PFNA及人工股骨头置换术均能有效治疗老年股骨转子间骨折,其中人工股骨头置换术术中出血少,手术时间短,病人能尽早下地,符合加速康复外科理念。Objective To explore the clinical efficacy and safety of hemiarthroplasty and proximalfemoral nail anti-rotation(PFNA) in the treatment of femoral intertrochanteric fracture in the elderly patients.Methods From February 2012 to February 2015,the clinical data of 65 elderly patients with femoralintertrochanteric fracture were retrospectively analyzed.All cases were divided into two groups:31 cases treatedwith hemiarthroplasty in the hemiarthroplasty group and 34 cases treated with PFNA in PFNA group.Theoperation conditions,pain,length of hospital stay,and healing time of fracture,the Harris score at the first yearafter operation and complications were compared between two groups.Results There was no one who sufferedfrom surgical incision infection during hospitalization.The operation time in hemiarthroplasty group was(46.20±10.12) min and that in PFNA group was(76.71±30.47) min.The blood loss during operation in hemiarthroplastygroup was(129.38 ± 70.20) m L and that in PFNA group was(301.43 ± 168.44) m L.The difference wasstatistically significant(t=-47.37,P<0.0001;t=-41.41,P<0.0001).At the 3rd day after surgery,the VASscore in hemiarthroplasty group was 1.06±1.73 and that in PFNA group was 0.94±1.61,with the Differencebeing not significant between the two groups.The activity time in hemiarthroplasty group was(1.94±1.44) days,which was significantly shorter than that in PFNA group(5.50±1.64 days)(t=-9.291,P<0.0001).The fracturehealing time was 6 to 11 weeks and the excellent rate by the Harris score at the last follow-up was 87.1% inhemiarthroplasty group,and those in PFNA group was 6 to 12 weeks and 85.3%,with the difference being notstatistically significant.In hemiarthroplasty group,there was 1 case of prosthesis fracture and 1 case ofprosthesis loosening.In PFNA group,there were 3 deaths,2 cases of internal fixation infection,3 cases of screwloosening,and 1 case of nonunion.Conclusion PFNA and hemiarthroplasty were effective methods for thetreatment of femoral intertrochanteric fractures of the elderly

关 键 词：髋骨折 关节成形术 置换 髋 骨折固定术 内 内固定器 老年人 

分 类 号：R687.3[医药卫生—骨科学]