两种手术方式治疗老年股骨转子间骨折的疗效比较  

Comparison efficacy of two kinds of surgical methods for treatment of the femoral intertrochanteric fractures in the elderly

作　　者：何涛 侯绍平[1] 汪军[1] 宋晓飞 龙俊任[1] 田龙 赵芮 HE Tao;HOU Shao-ping;WANG Jun;SONG Xiao-fei;LONG Jun-ren;TIAN Long;ZHAO Rui(Dept of Orthopaedics,the People′s Hospital of Langzhong City,the Affiliated Langzhong Hospital of North Sichuan Medical College,Langzhong,Sichuan 637400,China)

机构地区：[1]阆中市人民医院,川北医学院附属阆中医院骨科,四川阆中637400

出　　处：《临床骨科杂志》2024年第3期409-413,共5页Journal of Clinical Orthopaedics

摘　　要：目的比较股骨近端防旋髓内钉(PFNA)与人工股骨头置换(FHR)治疗老年股骨转子间骨折的临床疗效。方法根据手术方式不同将100例老年股骨转子间骨折患者分为PFNA组(采用PFNA治疗,50例)与FHR组(采用FHR治疗,50例)。比较两组手术情况、骨折愈合情况、髋关节Harris评分、膝关节活动度以及并发症发生情况。结果两组均获得随访,时间6~12(6.63±2.28)个月。手术时间、术中出血量、术后引流量、输血量PFNA组均短(少)于FHR组(P<0.05)。住院时间FHR组短于PFNA组(P<0.05)。骨折愈合时间两组比较差异无统计学意义(P>0.05)。术后1个月膝关节屈曲活动度两组比较差异无统计学意义(P>0.05)。术后6个月髋关节Harris评分优良率FHR组高于PFNA组(P<0.05)。术后并发生发生率FHR组低于PFNA组(P<0.05)。结论与PFNA相比,FHR治疗老年股骨转子间骨折更适合骨质疏松、不能长期卧床的高龄患者,可减少卧床并发症的发生,患者恢复更快,但创伤较大。应根据患者病情、骨折类型及适应证选择合适的手术方式。Objective To compare the clinical efficacy of proximal femoral nail antirotation(PFNA)and artificial femoral head replacement(FHR)in the treatment of the femoral intertrochanteric fractures in elderly patients.Methods The 100 elderly patients with femoral intertrochanteric fractures were divided into PFNA group(50 cases were treated with PFNA)and FHR group(50 cases were treated with artificial FHR),according to different surgical methods.The operation status,fracture healing,hip Harris score,knee motion activity and complications were compared between the two groups.Results Both groups were followed up for 6~12(6.63±2.28)months.PFNA group was shorter(less)than FHR group in the operation time,intraoperative blood loss,postoperative drainage volume and blood transfusion volume(P<0.05).The hospitalization time in FHR group was shorter than that in PFNA group(P<0.05).There was no statistical difference in fracture healing time between the two groups(P>0.05).There was no statistical difference in knee flexion activity between the two groups at 1 month after surgery(P>0.05).At 6 months after operation,the excellent-good rate of hip Harris score in FHR group was higher than that in PFNA group(P<0.05).The postoperative complication incidence rate in FHR group was lower than that in PFNA group(P<0.05).Conclusions Compared with PFNA treatment,FHR treatment of elderly femoral intertrochanteric fracture is more suitable for elderly patients with osteoporosis and can not be bedridden for a long time,which can reduce the occurrence of bedridden complications,and patients can recover faster,but the trauma is greater.The appropriate surgical method should be selected according to the patient′s condition,fracture type and indication.

关 键 词：股骨转子间骨折 人工股骨头置换 股骨近端防旋髓内钉 老年人 

分 类 号：R683.42[医药卫生—骨科学] R687.3[医药卫生—外科学]