基于多准则决策的半髋关节置换术与PFNA治疗外侧壁粉碎股骨转子间骨折风险-效益评价  

Risk-benefit evaluation of hemiarthroplasty and PFNA for comminuted intertrochanteric fracture of lateral wall based on multi-criteria decision

作　　者：窦海伟 哈巴西·卡肯[1] 艾尼瓦尔·达毛拉 米尔阿里木·木尔提扎 赵巍[1] 它依尔江·举来提 王利[1] Dou Haiwei;Habasi Kaken;Ainiwaer·Da Maola;Mieralimu·muertizha;Zhao Wei;Tayierjiang·julaiti;Wang Li(Department of Orthopedics,Xinjiang Uygur Autonomous Region People's Hospital,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院骨科,乌鲁木齐市830001

出　　处：《中华老年骨科与康复电子杂志》2025年第1期14-21,共8页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：天山英才项目(TSYC202301A005)。

摘　　要：目的基于多准则决策的半髋关节置换术(FHR)与股骨近端防旋髓内钉(PFNA)治疗外侧壁粉碎的股骨转子间骨折(IFF)风险-效益评价。方法回顾性分析2018年6月至2022年8月于我院收治的94例外侧壁粉碎IFF患者的临床资料。根据手术方式不同分为FHR组(47例,行FHR治疗),其中男性17例,女性30例,平均年龄(74.29±8.09)岁,和PFNA组(47例,行PFNA内固定治疗),其中男性22例,女性25例,平均年龄(75.44±9.52)岁。建立FHR治疗外侧壁粉碎的IFF的MCDA模型。结果两组切口长度、临床疗效、术后负重时间、手术时间、住院时间、不良反应、术中出血量差异均有统计学意义(P<0.05),两组患者组间比较,术后、前后差值的QOL-BREF评分、凝血功能指标、Harris评分差异均有统计学意义(P<0.05)。与PFNA组相比,FHR组的效益高、风险低,当效益和风险都重要时,FHR组、PFNA组的效益-风险总值分别为75、62,且观察组100%优于对照组。MCDA模型的稳定性较好。结论与PFNA术式相比,FHR治疗外侧壁粉碎IFF的获益高于风险,可用于临床治疗外侧壁粉碎IFF。临床上FHR治疗外侧壁粉碎IFF的效益-风险可能优于PFNA术式。Objective Based on the multi-criteria decision-making model to evaluate the benefits and risks of artificial femoral head replacement(FHR)in the treatment of intertrochanteric fracture offemur(IFF).Methods Selected 94 patients with lateral wall comminuted IFF treated in our hospital from June 2018 to August 2022 were analyzed retrospectively.The patients were divided into PFNA group(47 cases,treated with PFNA internal fixation),there were 17 males and 30 females,with an average age of(74.29±8.09)years,and FHR group(47 cases,treated with FHR),there were 22 males and 25 females with an average age of(75.44±9.52)years.To establish a multi-criteria decision-making model of IFF treated with FHR for lateral wall comminution.Results There were differences in intraoperative blood loss,operation time,postoperative weight-bearing time,incision length,clinical effect,adverse reactions and hospital stay.There were differences in QOL-BREF score,coagulation function index and Harris score between the two groups.Compared with PFNA group,FHR group has higher benefit and lower risk.When both benefit and risk are important,the total benefit-risk value of FHR group and PFNA group is 75 and 62 respectively,and the observation group is 100%better than the control group.The stability of the multi-criteria decision evaluation model is good.Conclusions Compared with PFNA,the benefit of FHR in the treatment of lateral wall comminuted IFF outweighs the risk,and it could be used in clinical treatment of lateral wall comminuted IFF.Clinically,the benefit-risk of FHR in the treatment of lateral wall comminution of IFF may be better than thatofPFNA.

关 键 词：股骨转子间骨折 股骨近端防旋髓内钉 半髋关节置换术 效益与风险 多准则决策分析 

分 类 号：R68[医药卫生—骨科学]