股骨近端防旋髓内钉与半髋置换治疗90岁及以上高龄老年股骨转子间骨折的早期疗效比较  

Early outcome of proximal femoral nail antirotation and bipolar hemiarthroplasty in treatment of intertrochanteric fractures in elderly patients aged 90 years or more

作　　者：黄金承 史炎鑫 王振[1] 赵永强[1] 白玉[2] 王爱国[2] 金毅[1] 郑稼[1] Huang Jincheng;Shi Yanxin;Wang Zhen;Zhao Yongqiang;Bai Yu;Wang Aiguo;Jin Yi;Zheng Jia(Department of Orthopedics,Henan Provincial People's Hospital,Zhengzhou 450003,China;Department of Lower Extremity Orthopedics,Zhengzhou Orthopedics Hospital,Zhengzhou 450052,China)

机构地区：[1]河南省人民医院骨科,郑州450003 [2]郑州市骨科医院下肢骨科,450052

出　　处：《中华创伤杂志》2020年第6期490-495,共6页Chinese Journal of Trauma

基　　金：科技部国家重点研发计划(2017YFB1104100);河南省科技攻关项目(202102310113);河南省人民医院博士科研启动基金(2018Huangjincheng)。

摘　　要：目的比较股骨近端防旋髓内钉(PFNA)与半髋置换治疗90岁及以上高龄老年股骨转子间骨折患者的早期临床疗效。方法采用回顾性病例对照研究分析2017年1月—2018年6月河南省人民医院收治的43例老年股骨转子间骨折患者的临床资料,其中男12例,女31例;年龄90~102岁[(92.3±2.5)岁]。31例接受PFNA治疗(PFNA组),12例接受半髋置换治疗(半髋置换组)。比较两组手术时间、术中出血量、术后开始下地负重时间、输血比例、术后2周和3个月内并发症发生率、术后第12个月髋关节功能Harris评分、术后第12个月病死率。结果两组患者均获随访,PFNA组随访1~30个月[(19.1±9.8)个月],半髋置换组随访0.5~29个月[(18.6±10.6)个月]。PFNA组手术时间[(95.8±31.0)min]及术中出血量[(71.3±25.7)ml]少于半髋置换组[(128.8±40.5)min,(212.5±113.1)ml](P<0.05)。PFNA组术后开始下地负重时间为(43.9±31.9)d,长于半髋置换组的(5.9±2.8)d(P<0.05)。围术期PFNA组接受输血的患者比例(29%)显著低于半髋置换组(75%)(P<0.05)。术后2周内PFNA组并发症发生率(23%)与半髋置换组(42%)类似(P>0.05)。PFNA组术后3个月内并发症发生率(26%)与半髋置换组(42%)类似(P>0.05)。术后第12个月,PFNA组Harris评分[(56.3±32.3)分]与半髋置换组[(59.3±36.7)分]比较差异无统计学意义(P>0.05)。术后第12个月PFNA组病死率为19%,半髋置换组为25%(P>0.05)。结论虽然PFNA与半髋置换均能有效治疗90岁及以上老年股骨转子间骨折,但PFNA内固定手术时间短及术中出血量少,可能更适合作为治疗高龄股骨转子间骨折患者的首选方案。Objective To compare the early outcome of proximal femoral nail antirotation(PFNA)and bipolar hemiarthroplasty in treatment of intertrochanteric fractures in elderly patients aged 90 years or more.Methods A retrospective case-control study was conducted to analyze the clinical data of 43 elderly patients aged 90 years or more with intertrochanteric fractures admitted to Henan Provincial People's Hospital from January 2017 to June 2018.There were 12 males and 31 females,aged 90-102 years[(92.3±2.5)years].A total of 31 patients were treated by PFNA(PFNA group)and 12 patients by bipolar hemiarthroplasty(hemiarthroplasty group).Comparisons were made between the two groups in terms of operation time,intraoperative blood loss,time of weight bearing after operation,rate of blood transfusion,incidence of complications 2 weeks and 3 months after operation,Harris score 12 months after operation and mortality 12 months after operation.Results All patients were followed up for 1-30 months[(19.1±9.8)months]in PFNA group and for 0.5-29 months[(18.6±10.6)months]in hemiarthroplasty group.Operative time was(95.8±31.0)minutes in PFNA group,shorter than(128.8±40.5)minutes in hemiarthroplasty group(P<0.05).Intraoperative blood loss was(71.3±25.7)ml in PFNA group and(212.5±113.1)ml in hemiarthroplasty group(P<0.05).Time of weight bearing after operation was(43.9±31.9)days in PFNA group,longer than(5.9±2.8)days in hemiarthroplasty group(P<0.05).The perioperative blood transfusion rate in PFNA group(29%)was less than hemiarthroplasty group(75%)(P<0.05).Incidence of complications 2 weeks after operation was similar between PFNA group(23%)and hemiarthroplasty group(42%)(P>0.05).Incidence of complications 3 months after operation in PFNA group was 26%,similar with 42%in hemiarthroplasty group(P>0.05).Harris score 12 months after operation in PFNA group was(56.3±32.3)points,comparable to(59.3±36.7)points in hemiarthroplasty group(P>0.05).Mortality rate 12 months after operation was 19%in PFNA group and 25%in hemiarthroplasty gro

关 键 词：髋骨折 老年人 关节成形术 置换 髋 股骨近端防旋髓内钉 

分 类 号：R687.3[医药卫生—骨科学]