PFNA与FHR治疗老年人不稳定股骨转子间骨折的疗效对比  

Comparative Study of PFNA and FHR in the Treatment for Senile Instability Intertrochanteric Fracture

作　　者：赵家瑞 戴毅 秦琦 李跃军 王维山[1] 史晨辉[1] Zhao Jiarui;Dai Yi;Qin Qi(Department of Orthopedics Center,The First Affiliated Hospital of the Medical College of Shihezi University,Xinjiang 832000,China)

机构地区：[1]石河子大学医学院第一附属医院骨科中心,832000

出　　处：《医学研究杂志》2018年第10期32-36,共5页Journal of Medical Research

基　　金：国家自然科学基金资助项目(81160225;81260453;81360451);新疆兵团医药卫生专项基金资助项目(2013BA020);新疆兵团国际交流与合作专项基金资助项目(2012BC002;2011BC004);新疆兵团科技创新团队专项基金资助项目(2014CC002)

摘　　要：目的比较行股骨近端防旋髓内钉(PFNA)和人工股骨头置换(FHR)治疗老年人不稳定股骨转子间骨折的近期疗效。方法回顾性分析笔者医院2014年7月～2016年7月间收治的不稳定股骨转子间骨折的老年患者,分两组行PFNA和FHR手术治疗,观察并比较两组之间的住院费用、手术时间、术中出血、术后完全负重时间、手术并发症、髋关节功能评分(Harris评分)及日常生活自理能力(ADL)情况。结果两组患者在手术时间、术后并发症方面比较差异无统计学意义(P> 0. 05);PFNA组的住院费用、术中出血较FHR组低,术后完全负重时间较FHR组明显延长(P <0. 05)。Harris评分术后3～6个月随访时FHR组较PFNA组高(P <0. 05),12个月随访时差异无统计学意义(P> 0. 05),ADL评分两组比较差异无统计学意义(P> 0. 05)。结论 FHR适用于经济状况好、对生活质量要求高的患者;PFNA治疗较FHR可以减少住院医疗支出,并完全能满足老年患者术后生活自理的需要;在评价此类骨折的术后疗效时,应将老年人的生理功能与生活质量结合起来评估,会更有实际意义。Objective To compare the recent clinical curative effect of the proximal femoral nail antirotation(PFNA)and femoral head prosthetic replacement(FHR)for elderly patients with unstable intertrochanteric fracture.Methods The retrospective analysis was conducted on 86 elderly patients with unstable intertrochanteric fracture between July 2014 and July 2016,which divided into two groups of PFNA or FHR.The observation target include hospitalization expenses,operation time、intraoperative bleeding and surgical complications,postoperative full weight-bearing time,hip joint function score(Harris score)and the ability to care for daily life(ADL score)are analyzed.Results There was no significant difference between the two groups in operative time and postoperative complications(P>0.05).The hospitalization expenses and intraoperative bleeding in the PFNA group were lower than that in the FHR group,and the postoperative full weight-bearing time was significantly longer than that in the FHR group(P<0.05).The FHR group was higher than the PFNA group(P<0.05)in the 3-6 months after the operation of the Harris score,and no significant difference was found in the December follow-up.There was no significant difference in ADL score(P>0.05).Conclusion FHR is suitable for patients with good economical condition and ask for a higher quality of life.The treatment of PFNA can reduce hospitalization expenses and meet the needs of postoperative life self-care of elderly patients.When evaluating the postoperative effect of such fractures,it is more practical to evaluate the physiological function of the elderly and the quality of their lives.

关 键 词：股骨转子间骨折 股骨近端防旋髓内钉 人工股骨头置换 髋关节功能评分 日常生活自理能力 

分 类 号：R683.42[医药卫生—骨科学]