两种术式治疗≥90岁高龄股骨转子间骨折的疗效比较  

Efficacy comparison of two types of surgery methods on the femoral intertrochanteric fractures in the senile patients with aged≥90 years old

作　　者：陈丽媛 郭会利 吕婉秋 姚瑞鑫 CHEN Li-yuan;GUO Hui-li;LÜWan-qiu;YAO Rui-xin(Luoyang Work Department,Degree and Graduate Education,Henan University of Chinese Medicine,Zhengzhou,Henan 450000,China;SectionⅡ,Dept of Musculoskeletal Pain,Luoyang Orthopedic-Traumatological Hospital of Henan Province,Henan Provincial Orthopedic Hospital,Luoyang,Henan 471000,China)

机构地区：[1]河南中医药大学学位与研究生教育洛阳工作部,河南郑州450000 [2]河南省洛阳正骨医院(河南省骨科医院)肌骨疼痛二科,河南洛阳471000

出　　处：《临床骨科杂志》2024年第5期703-707,共5页Journal of Clinical Orthopaedics

基　　金：河南省科技厅科技攻关计划项目(编号:182102310467);河南省中医药管理局中医药科学研究专项(编号:2019ZY2086、2019ZY2096、20-21ZY2253)。

摘　　要：目的 比较股骨近端防旋髓内钉(PFNA)和人工股骨头置换(AFHR)治疗≥90岁高龄股骨转子间骨折的疗效。方法 将73例≥90岁高龄股骨转子间骨折患者按照手术方式不同分为AFHR组(采用AFHR治疗,38例)和PFNA组(采用PFNA治疗,35例)。比较两组围手术期指标、开始不负重行走时间、术后并发症发生情况。采用Harris评分评价髋关节功能。采用ADL评分评价患者生活自理能力和生活质量情况。结果 患者均获得随访,时间12~20个月。切口长度、术中出血量AFHR组长(多)于PFNA组(P<0.01);住院时间、开始不负重行走时间、术后并发症发生率AFHR组均短(低)于PFNA组(P<0.05)。Harris评分、ADL评分:术后3、6个月AFHR组均高于PFNA组(P<0.05);术后12个月两组比较差异均无统计学意义(P>0.05)。结论 AFHR与PFNA均能有效治疗≥90岁高龄股骨转子间骨折,PFNA治疗手术难度低、创伤小,但术后并发症发生率高;AFHR治疗卧床时间短且可使患者早期下床锻炼,能有效恢复患者早期髋关节功能和生活自理能力。Objective To compare the efficacy of artificial femoral head replacement(AFHr )and proximal femoral nail anti-rotation(PFNA)in the treatment of femroal intertrochanteric fractures in the senile patients with aged≥90 years old.Methods The 73 senile patients with aged≥90 years old who suffered from femoral intertrochanteric fractures were divided into AFHr group(38 cases were treated with AFHr )and PFNA group(35 cases were treated with PFNA fixation),according to different surgical methods.Perioperative indicators,start of weightless walking time,and incidence situation of postoperative complications were compared between two groups.The hip joint function was evaluated by using Harris score.ADL score was used to evaluate self-care ability and quality of life.Results All patients were followed up for 12~20 months.The length of the incision and intraoperative bleeding volume in the AFHr group were longer(more)than those in the PFNA group(P<0.01);the hospitalization time,start of weightless walking time,and incidence rate of postoperative complications in the AFHr group were all shorter(lower)than those in the PFNA group(P<0.05).Harris score and ADL score:After 3,6 months of surgery,the AFHr group were higher than the PFNA group(P<0.05);there were no statistical significance between two groups at 12 months after surgery(P>0.05).Conclusions Both AFHr and PFNA can effectively treat femoral intertrochanteric fracturesin patients with aged≥90 years old.PFNA fixation surgery has low difficulty and less trauma,but the incidence rate of postoperative complications is high;AFHr has a short bed rest time and can enable patients to get out of bed early for exercise,effectively restore early hip joint function and self-care ability.

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 高龄 

分 类 号：R683.42[医药卫生—骨科学] R687.33[医药卫生—外科学]