老年股骨转子间骨折人工股骨头置换术的临床结局分析  

Clinical Outcome of Hip Hemiarthroplasty on Intertrochanteric Fracture in Elderly Patients

作　　者：吴斌[1] 林明侠[1] 沈宁江[1] 符波[1] 蔡文涛[1] 龙彩雪[1] Wu Bin;Lin Mingxia;Shen Ningjiang(Department of Orthopaedics,People's Hospitalof Hainan,Haikou570100,China)

机构地区：[1]海南省人民医院骨科,海南海口570100

出　　处：《实用骨科杂志》2018年第12期1073-1076,1092,共5页Journal of Practical Orthopaedics

摘　　要：目的随访老年股骨转子间骨折患者人工股骨头置换术后的近期及远期临床结局。方法前瞻性观察2014年1月至2017年1月期间,因股骨转子间骨折住院治疗的163例老年患者,男性74例,女性89例;年龄60～98岁,平均年龄(78.20±10.71)岁。根据患者治疗意愿给予股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定术(76例)或人工股骨头置换术(87例),观察患者出院时间及术后满1年时的功能独立性评定得分结果(functional independence measure,FIM)以及死亡病例数。结果全部患者均在术后1年进行终末随访。在手术满1年时共有50例(30.67%)已死亡,其中关节置换术组死亡22例,内固定组死亡28例,两组间差异无统计学意义(P>0.05)。出院时关节置换术组患者的平均FIM得分(80.07±11.34)分优于内固定组(70.03±12.48)分(P<0.05);术后1年存活患者的组间比较,关节置换术组患者的平均FIM得分(97.34±9.78)分高于内固定组(92.23±9.70)分(P<0.05)。出院时的FIM得分与年龄、术前等待时间、输血量有关。结论人工股骨头置换术治疗老年股骨转子间骨折较PFNA内固定术更有助于恢复患者早期及远期的独立功能,但术后1年死亡率比较两组差异无统计学意义。Objective To evaluate functional recovery and mortality through one year follow-up after surgery of intertrochanteric fracture by PFNA osteosynthesis and hip hemiarthroplasty.Methods A total of 163 consecutive patients(74 males and 89 females,average age 78.20±10.71 years)with intertrochanteric fractures were divided into osteosynthesis group and arthroplasty groups according to treatment techniques.We evaluated patient mortality and functional status according to Functional Independence Measure(FIM)scores.FIM were assessed atdischarge from the hospitaland one year after surgeries.Results Inthe follow-up1 year after surgery,50 patients had died(30.67%).22 patientswere from the arthroplasty group and 28 from osteosynthesis group(P>0.05).The arthroplasty group had significantly higher FIM when they discharged from the hospital(80.07±11.34)and one year after surgery(97.34±9.78,P<0.05).Patient age,time to surgery,and transfusion volumewere detected as significant related factors of FIM.Conclusion Functional loss resulted from intertrochanteric fractures can be reduced by arthroplasty instead of osteosynthesis.No significant differencein mortality through one year of follow-up was observed between arthroplasty and osteosynthesis surgeries.

关 键 词：髋部骨折 老年骨科 关节置换 骨折固定 功能独立评定 

分 类 号：R683.42[医药卫生—骨科学]