双极长柄人工股骨头置换与股骨近端防旋髓内钉置入治疗高龄股骨转子间骨折的比较  

Comparison of bipolar long-stalk artificial femoral head replacement and proximal femoral nail antirotation in the treatment of intertrochanteric fracture of senile femur

作　　者：张建[1] 杨阳[1] 龚泰芳[2] 张江[2] 于云祥[2] Zhang Jian;Yang Yang;Gong Taifang;Zhang Jiang;Yu Yunxiang(Hubei University of Medicine,Shiyan 442000,Hubei Province,China;Department of Bone Joint and Sports Medicine,Taihe Hospital Affiliated to Hubei University of Medicine,Shiyan 442000,Hubei Province,China)

机构地区：[1]湖北医药学院,湖北省十堰市442000 [2]湖北医药学院附属太和医院骨关节与运动医学科,湖北省十堰市442000

出　　处：《中国组织工程研究》2020年第36期5825-5831,共7页Chinese Journal of Tissue Engineering Research

基　　金：十堰市科技攻关项目(14Y23),项目负责人:龚泰芳。

摘　　要：背景:股骨转子间骨折是老年人的常见骨折之一,现在骨科医师普遍主张早期手术治疗,以双极长柄人工股骨头置换和股骨近端防旋髓内钉为主。两种方案都能很好地保证患者早期下床活动,减少卧床期间产生的并发症,但在手术适应证上两种方案仍存在较大的争议。目的:分析双极长柄人工股骨头置换与股骨近端防旋髓内钉治疗高龄患者股骨转子间骨折的临床差异性。方法:纳入200例75岁以上Tronzo-EvansⅡ-Ⅴ型股骨转子间骨折患者,术后随访12个月,失访11例,共189例完成随访,其中双极长柄人工股骨头置换组95例,股骨近端防旋髓内钉组94例。比较2组手术时间、术中出血量、术后下床活动时间(开始负重、完全负重)、术前术后凝血功能、住院期间的并发症及住院时间等围术期参数;依据Harris功能评分比较2组患者术后的髋关节功能;根据临床和影像学资料比较2组术后12个月内出现的并发症。结果与结论:①双极长柄人工关节置换组手术时间和术后负重时间(术后开始下床活动时间、术后完全下床活动时间)均小于股骨近端防旋髓内钉组(P <0.05);②术后1,2,3,6个月Harris评分,双极长柄人工关节置换组均高于PFNA组(P <0.05);术后1年2组Harris评分相近,差异无显著性意义(P> 0.05);③术后并发症中2组下肢静脉血栓、肺部感染发生率差异有显著性意义(P <0.05);伤口感染、二次手术发生率2组差异无显著性意义(P> 0.05);总体并发症发生率,双极长柄人工关节置换组为20%,股骨近端防旋髓内钉组为72%,2组相比差异有显著性意义(P <0.05);④结果表明,对于高龄不稳定转子间骨折患者,双极长柄人工关节置换与股骨近端防旋髓内钉内固定均能取得满意效果;但双极长柄人工关节置换的手术时间短,可早期负重,有助于减少长期卧床相关并发症,符合快速康复的理念,可提高患者生活质量。BACKGROUND:Intertrochanteric fractures of the femur are one of the most common fractures in the elderly.For the treatment of intertrochanteric fractures,early surgical treatment is now generally advocated by orthopedic surgeons,mainly bipolar long-stalk artificial femoral head replacement and proximal femoral nail antirotation.Both of the two schemes can well ensure the patients’out-of-bed activities and reduce the complications during the stay in bed.However,there is still a great controversy on the indications of the two schemes.OBJECTIVE:To analyze the clinical differences between bipolar long-stalk artificial femoral head replacement and proximal femoral nail antirotation in the treatment of intertrochanteric fractures in elderly patients.METHODS:Totally 200 patients aged older than 75 years old with Tronzo-Evans II-V femoral fractures were enrolled,and followed up for 12 months.Eleven cases lost to follow up.Totally 189 cases completed the follow-up.Among them,there were 95 cases of bipolar long-stalk artificial femoral head replacement and 94 cases of proximal femoral nail antirotation.Perioperative parameters,such as operation time,intraoperative blood loss,postoperative time of getting out of bed(beginning load bearing,complete load bearing),preoperative and postoperative coagulation function,complications during hospitalization and length of stay,were compared between the two groups.The postoperative hip function of the two groups was compared according to Harris functional score.Clinical and radiographic data were used to compare the complications within 12 months after surgery between the two groups.RESULTS AND CONCLUSION:(1)The operation time and postoperative weight-bearing time(starting to get out of bed after surgery,and the time to get out of bed completely after surgery)of the bipolar long-stalk artificial femoral head replacement group were lower than those of the proximal femoral nail antirotation group(P<0.05).(2)Harris scores at 1,2,3 and 6 months after operation were higher in the bipolar

关 键 词：骨 骨折 股骨 转子间骨折 关节置换 假体 髓内钉 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]