防旋转股骨近端髓内钉与人工关节置换治疗老年股骨转子间骨折的比较  

Comparison of proximal femoral nail antirotation and artificial hip joint replacement in the treatment of intertrochanteric fractures in the elderly patients

作　　者：汪洋 彭家全[1] 唐春江 胡财杰 熊卫平 刘春[1] WANG Yang;PENG Jiaquan;TANG Chunjiang;HU Caijie;XIONG Weiping;LIU Chun(Department of Orthopedics,the Second People′s Hospital of Jiangjin District,Chongqing 402289,China)

机构地区：[1]重庆市江津区第二人民医院骨科,402289

出　　处：《重庆医学》2018年第20期2706-2708,2713,共4页Chongqing medicine

摘　　要：目的比较防旋转股骨近端髓内钉(PFNA)与人工髋关节置换治疗老年股骨转子间骨折的临床疗效。方法回顾性分析2014年6月至2016年6月该院接诊的134例老年股骨转子间骨折的患者,按手术方式分为PFNA组(n=65)和人工关节组(n=69)。比较两组患者术前一般临床资料、手术时间、术中出血量、下床活动时间、住院时间、术后并发症发生情况及术后1年髋关节改良Harris功能评定结果。结果 PFNA组患者手术时间明显短于人工关节置换组,术中出血量显著少于人工关节置换组,两组比较差异有统计学意义(P<0.05)。但PFNA组下床活动时间和住院时间显著长于人工关节置换组,两组比较差异有统计学意义(P<0.05)。术后1年,两组患者髋关节改良Harris关节功能评估优良率均较高,但人工关节置换组优良率(94.20%)高于PFNA组(83.08%),两组比较差异有统计学意义(P<0.05)。两组患者总并发症发生率均较低,且人工关节置换组(5.80%)低于PFNA组(18.46%),两组比较差异有统计学意义P<0.05)。结论 PFNA固定术和人工髋关节置换术两种方法治疗老年股骨转子间骨折,均可以取得较为满意的疗效。PFNA固定术的手术创伤小于人工髋关节置换术,但人工髋关节置换术后髋关节功能恢复更好,并发症发生率更低。Objective To compare the efficacy of proximal femoral nail antirotation(PFNA)and artificial hip joint replacement in the treatment of intertrochanteric fractures in the elderly patients.Methods A total of 134 patients with intertrochanteric fractures from June 2014 to June 2016 in this hospital were divided into the PFNA group(n=65)and the artificial joint group(n=69)according to the operation.The general clinical data,the operative time,the amount of intraoperative blood loss,the time of getting out of bed,the time of hospital stay,postoperative complications and the results of Harris function evaluation were compared.Results Compared with the artificial joint group,the operative time and the amount of intraoperative blood loss of the PFNA group were significantly lower,the time of getting out of bed and the time of hospital stay were significantly longer,there were statistically significant differences(P<0.05).One year after surgery,both groups had better hip function assessment,but the excellence rate of the artificial joint group(94.20%)was higher than that of the PFNA group(83.08%),the difference was statistically significant(P<0.05).The incidence of total complications of the artificial joint group(5.80%)was lower than that of the PFNA group(18.46%),there was statistically significant difference(P<0.05).Conclusion Both PFNA fixation and artificial hip replacement can get satisfactory results.Surgical trauma of PFNA was smaller than that of artificial hip replacement,but hip function recovery of artificial hip replacement is better and the incidence of complications is lower.

关 键 词：转子间骨折 防旋转股骨近端髓内钉 人工髋关节置换 

分 类 号：R683.42[医药卫生—骨科学]