两种术式治疗股骨头置换后对侧股骨粗隆间骨折比较  

Comparison of two surgical strategies for contralateral unstable intertrochanteric fractures secondary to primary femoral head replacement in elderly

作　　者：包杭生[1] 冯宗权[1] 邹勇根[1] 陈坚锋[1] BAO Hang-sheng;FENG Zong-quan;ZOU Yong-gen;CHEN Jian-feng(Orthopedic Department,Foshan Hospital of Traditional Chinese Medicine,Foshan 528000,China)

机构地区：[1]佛山市中医院骨伤科,广东佛山528000

出　　处：《中国矫形外科杂志》2020年第24期2218-2222,共5页Orthopedic Journal of China

基　　金：国家临床重点专科(中医专业)骨伤科补助资金建设项目(财社[2012]122号,粤财社[2012]312号)。

摘　　要：[目的]比较股骨近端防旋髓内钉(proximal femoral intermedullary nail anti-rotation, PFNA)内固定与骨水泥型股骨头置换(femoral head replacement, FHR)治疗老年股骨头置换后再发对侧不稳定股骨粗隆间骨折的临床效果。[方法]回顾性分析老年股骨头置换术后再发对侧不稳定股骨粗隆间骨折67例患者,其中33例采用PFNA,34例采用FHR。比较两组围手术期、随访和影像资料。[结果] PFNA组手术时间、术中出血量均显著优于FHR组(P<0.05);但PFNA组下地负重行走时间显著不及FHR组(P<0.05)。两组间总体并发症发生率差异无统计学意义(P>0.05),两组间1年内死亡率的差异无统计学意义(P>0.05)。随时间推移,两组患者Harris、ADL和SF-36评分均显著增加(P<0.05)。术前两组间Harris、ADL和SF-36评分的差异均无统计学意义(P>0.05),术后3个月上述各项评分FHR组显著优于PFNA组(P<0.05),但术后6个月及术后1年两组间上述评分差异无统计学意义(P>0.05)。影像方面,PFNA组复位优良率为90.91%,除内固定松动并切割股骨头1例外,其余骨折均完全愈合。FHR组末见假体松动。[结论]两种术式治疗股骨头置换后对侧股骨粗隆间骨折的临床结果相似,各有优缺点。[Objective] To compare the clinical outcomes of proximal femoral intermedullary nail anti-rotation(PFNA) versus femoral head replacement(FHR) for the contralateral unstable intertrochanteric fractures secondary to primary femoral head replacement in the elderly. [Methods] A retrospective study was done on 67 elderly patients who were surgically treated for the contralateral unstable intertrochanteric fractures secondary to femoral head replacement on one side. Of them, 33 patients received PFNA, while the remaining 34 patients underwent FHR. The two groups were compared regarding perioperative, followup and radiographic data. [Results] The PFNA group proved significantly superior to the FHR group in operation time and intraoperative blood loss(P<0.05), whereas the former was significantly inferior to the latter in the time to return ambulation(P<0.05). There were no statistically significant differences in total complication rate and death rate within 1 year between the two groups(P>0.05). As time went the Harris, ADL and SF-36 scores significantly increased in both groups(P<0.05). Although there were no significant differences in Harris, ADL and SF-36 scores between the two groups before operation(P>0.05), the aforesaid scores proved significantly superior in the FHR group to the PFNA group at 3 months postoperatively(P<0.05), which became not statistically significant at 6 and 12 months postoperatively(P>0.05). In term of radiographic assessment, the PFNA group got fracture reduction with excellent and good rate of 90.91%, and bony healing to the latest follow-up in all patients but one who had implant loosening and cutting out the femoral head. In contrast, the FHR group had no prosthetic loosening in anyone of the patients. [Conclusions] The two surgical procedures do achieve similar clinical outcomes for the contralateral unstable intertrochanteric fractures secondary to primary femoral head replacement in the elderly with advantages and disadvantages in each way.

关 键 词：股骨粗隆间骨折 股骨头置换 骨水泥 股骨近端防旋转髓骨钉 老年人 

分 类 号：R683.42[医药卫生—骨科学]