股骨近端防旋髓内钉固定治疗高龄股骨粗隆间骨折的手术时机选择  

Timing of proximal femoral nail antirotation in the treatment of intertrochanteric fractures in elderly patients

作　　者：史博 SHI Bo(Fushun Hospital of Traditional Chinese Medicine,Fushun 113006,China)

机构地区：[1]辽宁省抚顺市中医院,113006

出　　处：《中国现代药物应用》2020年第20期35-37,共3页Chinese Journal of Modern Drug Application

摘　　要：目的探讨高龄股骨粗隆间骨折患者应用股骨近端防旋髓内钉(PFNA)治疗的手术时机。方法120例高龄股骨粗隆间骨折患者,根据进行手术的时间不同分为A组(手术时间≤48 h,64例)和B组(手术时间>48 h,56例)。A组患者伤后≤48 h行股骨近端防旋髓内钉固定术,B组患者伤后>48 h行股骨近端防旋髓内钉固定术。比较两组患者围手术期情况、并发症(脱位、感染、假体松动、异位骨化、疼痛、静脉血栓)发生情况、术前和术后6个月髋关节Harris评分、随访1年的死亡情况。结果A组手术时间(71.27±22.13)min、术中出血量(168.19±50.14)ml与B组的(73.13±21.79)min、(171.05±47.69)ml比较,差异无统计学意义(P>0.05)。A组住院时间(12.13±2.73)d短于B组的(15.69±3.77)d,住院费用(27133.25±7354.14)元少于B组的(34937.14±7564.25)元,差异均具有统计学意义(P<0.05)。A组患者并发症发生率6.25%低于B组的17.86%,差异具有统计学意义(P<0.05)。术后6个月,A组患者髋关节Harris评分(74.56±6.83)分高于B组的(64.99±6.14)分,差异具有统计学意义(P<0.05)。A组随访1年死亡率7.8%明显低于B组的21.4%,差异具有统计学意义(P<0.05)。结论高龄股骨粗隆间骨折患者应尽早手术,早期手术能减少并发症,促进患者康复,利于髋关节功能恢复,降低死亡率。Objective To discuss the timing of proximal femoral nail antirotation(PFNA)in the treatment of intertrochanteric fractures in elderly patients.Methods A total of 120 elderly patients with intertrochanteric fractures were divided into group A(operation time≤48 h,64 cases)and group B(operation time>48 h,56 cases)according to different timing of operation.Group A underwent proximal femoral nail antirotation≤48 h after surgery,and group B underwent proximal femoral nail antirotation>48 h after surgery.The perioperative situation,occurrence of complications(dislocation,infection,prosthesis loosening,heterotopic ossification,pain,venous thrombosis),Harris score of hip joint before and 6 months after operation,and death rate after 1 year follow-up were compared between the two groups.Results The operation time(71.27±22.13)min and amount of intraoperative hemorrhage(168.19±50.14)ml of group A had no statistically significant difference compared with(73.13±21.79)min and(171.05±47.69)ml of group B(P>0.05).The hospitalization time(12.13±2.73)d of group A was shorter than(15.69±3.77)d of group B,and hospitalization costs(27133.25±7354.14)yuan was less than(34937.14±7564.25)yuan of group B,and the difference was statistically significant(P<0.05).The incidence of complications 6.25%of group A was lower than 17.86%of group B,and the difference was statistically significant(P<0.05).6 months after operation,Harris score of hip joint(74.56±6.83)points of group A was higher than(64.99±6.14)points of group B,and the difference was statistically significant(P<0.05).The 1-year death rate 7.8%of group A was obviously lower than 21.4%of group B,and the difference was statistically significant(P<0.05).Conclusion Elderly patients with femoral intertrochanteric fractures should undergo surgery as soon as possible.Early surgery can reduce complications,promote patient recovery,facilitate the recovery of hip joint function,and reduce mortality.

关 键 词：股骨近端防旋髓内针固定术 高龄 股骨粗隆间骨折 手术时机 

分 类 号：R687.3[医药卫生—骨科学]