PFNA与人工股骨头置换术治疗老年不稳定性股骨粗隆间骨折的效果研究  

Study on effect of PFNA and artificial femoral head replacement in the treatment of unstable intertrochanteric fracture of femur in the elderly

作　　者：李相才 蒋冬升[2] LI Xiang-cai;JIANG Dong-sheng(Department of Orthopedics,Affiliated Hospital of Heze Medical College,Heze 274000,China)

机构地区：[1]菏泽医学专科学校附属医院骨外科,274000 [2]菏泽医学专科学校骨外科,274000

出　　处：《中国实用医药》2023年第13期54-57,共4页China Practical Medicine

摘　　要：目的 分析股骨近端防旋髓内钉(PFNA)与人工股骨头置换术治疗老年不稳定性股骨粗隆间骨折(IFF)的效果。方法 96例老年不稳定性IFF患者,按照随机数字表法分为研究组与对照组,每组48例。对照组患者接受PFNA内固定治疗,研究组患者接受人工股骨头置换术治疗。比较两组术中失血量、手术操作时间、术后引流量、术后并发症发生情况及术前、术后3个月的Harris髋关节功能量表(HSS)评分、改良Barthel指数。结果 研究组患者术中失血量(402.52±56.50)ml、术后引流量(200.44±43.02)ml多于对照组的(188.65±30.52)、(65.50±20.45)ml,手术操作时间(68.52±15.00)min长于对照组的(49.65±14.78)min,差异有统计学意义(P<0.05)。术后3个月,研究组患者HSS评分、改良Barthel指数分别为(82.68±6.04)、(75.50±5.85)分,高于对照组的(72.55±5.54)、(67.85±6.40)分,差异具有统计学意义(P<0.05)。研究组患者术后并发症发生率为2.08%,低于对照组的16.67%,差异具有统计学意义(P<0.05)。结论 PFNA治疗老年不稳定性IFF具有创伤小、出血少等特点,但人工股骨头置换术更利于术后髋关节康复,且降低了术后并发症发生风险,保障患者的日常生活活动能力,适于临床推广。Objective To analyze the effect of proximal femoral nail anti-rotation(PFNA)and artificial femoral head replacement in the treatment of unstable intertrochanteric fracture of femur(IFF)in the elderly.Methods A total of 96 elderly patients with unstable IFF were divided into research group and control group according to random numerical table,with 48 cases in each group.The control group was treated with PFNA internal fixation,and the research group was treated with artificial femoral head replacement.The intraoperative blood loss,operative time,postoperative drainage volume,postoperative complications,Hospital for Special Surgery(HSS)score and modified Barthel index before and 3 months after surgery were compared between the two groups.Results The intraoperative blood loss of(200.44±43.02)ml and postoperative drainage volume of(402.52±56.50)ml in the research group were higher than those of(188.65±30.52)and(65.50±20.45)ml in the control group;the operative time of(68.52±15.00)min in the research group was longer than that of(49.65±14.78)min in the control group;the differences were statistically significant(P<0.05).3 months after surgery,the HSS score and modified Barthel index were(82.68±6.04)and(75.50±5.85)points in the research group,which were higher than those of(72.55±5.54)and(67.85±6.40)points in the control group,and the differences were statistically significant(P<0.05).The incidence of postoperative complications was 2.08%in the research group,which was lower than that of 16.67%in the control group,and the difference was statistically significant(P<0.05).Conclusion PFNA has the characteristics of less trauma and less bleeding in the treatment of elderly unstable IFF,but artificial femoral head replacement is more conducive to postoperative hip rehabilitation,and reduces the risk of postoperative complications and guarantees patients'ability to perform daily activities,which is suitable for clinical promotion.

关 键 词：股骨近端防旋髓内钉 人工股骨头置换术 股骨粗隆间骨折 不稳定性 老年 

分 类 号：R687.3[医药卫生—骨科学]