DHS、PFNA、半髋关节置换术治疗老年不稳定性股骨转子间骨折的疗效对比  

Comparative evaluation of proximal femoral nail antirotation,dynamic hip screw or hip hemiarthroplasty in unstable intertrochanteric fractures of elderly patients

作　　者：孟庆奇 崔树廷[2] 梁伟国 王文 李爱国 李锋生 张同仁 王敏 奉振成 李斯明 MENG Qingqi;CUI Shuting;LIANG Weiguo;WANG Wen;LI Aiguo;LI Fengsheng;ZHANG Tongren;WANG Min;FENG Zhencheng;LI Siming(Orthopedics Department,Guangzhou Red Cross Hospital,Medical College,JiNan University,Guangdong 510220,China)

机构地区：[1]广州市红十字会医院暨南大学医学院附属广州红十字会医院骨科,广州510220 [2]泰山医学院附属聊城二院骨科,山东聊城252000

出　　处：《实用医学杂志》2019年第7期1036-1039,1043,共5页The Journal of Practical Medicine

摘　　要：目的对比评估动力髋螺钉(DHS)、防旋股骨近端髓内钉(PFNA)及半髋关节置换术治疗老年不稳定性股骨转子间骨折的优缺点及并发症。方法以AO分型为标准,筛选92例70岁以上老年不稳定性股骨转子间骨折患者,对比3种术式患者的一般情况、术后足趾触地和完全负重的时间、HHS、术中出血量、术后输血率及并发症。结果 PFNA在术中出血量和输血率方面要要优于其余两种术式。半髋关节置换则可以获得最优的负重开始时间,包括足趾触地时间和全负重时间,及3个月内的最佳的HSS分值。结论对于老年不稳定性股骨转子间骨折,如果患者耐受手术能力差,考虑到术中出血及术后早期下地,建议给予PFNA治疗。如果患者身体状况可,因为3种术式远期效果一致,应综合考虑患者的骨折类型、骨折复位难易、经济状况及术者对各种术式熟练程度做出选择。Objective To evaluate the advantages,disadvantages and complication associated with fixation of unstable intertrochanteric fractures in elderly patients with proximal femur nailing,dynamic hip screw and hip hemiarthroplasty.Methods 92 patients over 70 years old with unstable intertrochanteric fractures were selected according to AO classification.To compare the characteristic,toe touch weight bearing and full weight bearing,H arris hip score,blood loos in operation,transfusion post operation,and complications of patients in DHS,P FNA and hemiarthroplasty group.Results PFNA was superior to the other two surgeries in terms of intraoperative blood loss and blood transfusion rate post-operation.Hemiarthroplasty could provide the best chose in bearing weight and HHS in the early three month after surgery.Conclusion For elderly patients with poor general health status,it is better to choose PFNA treatment for the less blood loss and early weight bearing.And if the patient with a good health status,then the fracture types,difficulties in reduction,economic status of family,and the surgeon′s choice should be considered,because the long term effects of the three surgery have no difference.

关 键 词：不稳定性股骨转子间骨折 防旋股骨近端髓内钉(PFNA) 动力髋螺钉(DHS) 半髋关节置换 

分 类 号：R687.3[医药卫生—骨科学]