3种手术方式治疗老年股骨粗隆间骨折的近期疗效分析  

Short-term effect of three surgical methods in treatment of femoral intertrochanteric fracture in the elderly

作　　者：陈阳 宋长福 杨军[2] 段野 岳明 CHEN Yang;SONG Chang-fu;YANG Jun;DUAN Ye;YUE Ming(Department of Orthopaedics,Shenyang Cancer Hospital/Shenyang Fifth People’s Hospital,Shenyang Liaoning 110023,China;Department of Orthopaedics,Shengjing Hospital Affiliated to China Medical University,Shenyang Liaoning 110004,China)

机构地区：[1]沈阳市肿瘤医院/沈阳市第五人民医院骨科,辽宁沈阳110023 [2]中国医科大学附属盛京医院骨科,辽宁沈阳110004

出　　处：《局解手术学杂志》2020年第11期871-875,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：辽宁省自然科学基金指导计划(20170269)。

摘　　要：目的探讨股骨近端防旋髓内钉(PFNA)内固定、人工股骨头置换术及解剖型锁定钢板(PF-LCP)内固定治疗老年股骨粗隆间骨折的近期疗效。方法回顾性分析2016年3月至2018年7月沈阳市第五人民医院骨科收治的90例老年股骨粗隆间骨折患者的临床资料,根据手术方式的不同将其分为PF-LCP内固定组、PFNA内固定组和人工股骨头置换术组,每组30例。比较3组患者的围术期相关指标,Harris髋关节功能评分、优良率及术后并发症。结果3组患者手术时间、住院时间比较,差异无统计学意义(P>0.05);PFNA内固定组切口长度最短、术中失血量最少,人工股骨头置换术组切口长度最长、术中失血量最多,3组比较差异均有统计学意义(P<0.05);人工股骨头置换术组术后完全负重时间最短,其次是PFNA内固定组,PF-LCP内固定组术后完全负重时间最长,3组比较差异均有统计学意义(P<0.05)。PFNA内固定组、人工股骨头置换术组的临床优良率均高于PF-LCP内固定组(P<0.05),但PFNA内固定组与人工股骨头置换术组比较,差异无统计学意义(P>0.05)。PFNA内固定组、人工股骨头置换术组术后3、6、12个月的Harris髋关节功能评分高于PF-LCP内固定组(P<0.05),但PFNA内固定组与人工股骨头置换术组比较,差异无统计学意义(P>0.05)。3组患者术后并发症总发生率比较差异无统计学意义(P>0.05)。结论与PF-LCP内固定治疗相比,PFNA内固定和人工股骨头置换术治疗老年股骨粗隆间骨折近期疗效更好,PFNA内固定对患者造成的创伤更小,而人工股骨头置换术可让患者早日进行负重康复训练。Objective To explore the short-term effect of proximal femoral nail antirotation(PFNA)internal fixation,artificial femoral head replacement and proximal femur locking compression plate(PF-LCP)internal fixation in the treatment of femoral intertrochanteric fracture in the elderly.Methods The clinical data of 90 elderly patients with femoral intertrochanteric fracture who were treated in orthopedics department of Shenyang Fifth People’s Hospital from March 2016 to July 2018 were retrospectively analyzed.According to different surgical methods,the patients were divided into the PF-LCP internal fixation group,the PFNA internal fixation group and the artificial femoral head replacement group,with 30 patients in each group.The perioperative indexes,Harris hip function scores,the excellent and good rate,and postoperative complications of the three groups were compared.Results There was no significant difference in operation time and hospital stay among the three groups(P>0.05).The PFNA internal fixation group had the shortest incision length and the least intraoperative blood loss,and the artificial femoral head replacement group had the longest incision length and the greatest intraoperative blood loss,there were statistically significant differences among the three groups(P<0.05).The artificial femoral head replacement group had the shortest postoperative full weight-bearing time,followed by the PFNA internal fixation group,and the PF-LCP internal fixation group had the longest postoperative full weight-bearing time,with statistically significant differences among the three groups(P<0.05).The clinical excellent and good rate of the PFNA internal fixation group and the artificial femoral head replacement group were higher than that of the PF-LCP internal fixation group(P<0.05),but no significant difference was found between the PFNA internal fixation group and the artificial femoral head replacement group(P>0.05).Harris hip function scores 3,6 and 12 months after surgery in the PFNA internal fixation group and the ar

关 键 词：锁定钢板 老年 人工股骨头置换术 股骨粗隆间骨折 疗效 防旋髓内钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]