基于高龄骨质疏松患者不稳定型股骨粗隆间骨折的不同术式讨论  

Discussion of different operation methods based on unstable intertrochanteric fracture of femur in elderly patients with osteoporosis

作　　者：马宁 董乐乐[1] Ma Ning;Dong Lele(Department of Orthopetics,the First Affiliated Hospital of Baotou Medical College,Baotou,Inner Mongolia)

机构地区：[1]包头医学院第一附属医院骨科,内蒙古包头

出　　处：《运动科学与健康研究》2025年第2期40-47,52,共9页Research on Sports Science and Health

摘　　要：目的:比较水泥型加长柄人工股骨头置换与股骨近端防旋髓内钉(PFNA)治疗80岁以上骨质疏松患者不稳定型股骨粗隆间骨折(ITF)的临床疗效。方法:回顾性分析我院2022年9月~2024年6月收治的64例ITF患者,分为关节置换组和PFNA组,对比两组手术指标和功能评分。采用Logistic回归和ROC曲线分别分析术后谵妄的危险因素和评估其诊断效能。结果:(1)手术指标:PFNA组手术时间(92.82±8.14 min)、出血量(133.18±44.20 ml)和切口长度(6.85±1.12 cm)均优于关节置换组(P<0.05),但PFNA组术后负重时间(4.27±0.52w)和隐性失血量(688.59±38.92ml)均显著高于关节置换组(P<0.05)。(2)功能评分:关节置换组术后1、3、6个月髋关节Harris评分及Barthel日常生活能力评分均高于PFNA组(P>0.05),但1年后两组无显著差异(P>0.05)。(3)并发症:关节置换组并发症发生率(20%)显著低于PFNA组(44.1%,P<0.05)。(4)谵妄风险:手术方式和隐性失血量为术后谵妄的独立危险因素,隐性失血量的曲线下面积(AUC)为0.817(P<0.05),具有显著诊断价值。结论:(1)PFNA在手术简便性和创伤性上占优势,而关节置换在早期功能恢复、减少谵妄及并发症方面更具优势;(2)隐性失血量是术后谵妄的重要预测指标,临床应重点关注;(3)对于骨质疏松严重且需早期下地活动的患者,关节置换是治疗高龄不稳定ITF的重要补充选择。Objective:To compare the clinical efficacy of cement-type extended shank artificial femoral head replacement and Proximal Femoral Nail Antirotation(PFNA)in the treatment of unstable Intertrochanteric Fracture(ITF)in osteoporosis patients over 80 years old.Methods:64 patients with ITF admitted to our hospital from September 2022 to June 2024 were retrospectively analyzed,divided into joint replacement group and PFNA group,and the surgical indexes and functional scores of the two groups were compared.Logistic regression analysisand ROC curveswere used to analyze the risk factors and evaluate the diagnostic efficacy of postoperative delirium.Results:(1)Surgical indexes:Operation time(92.82±8.14 min),blood loss(133.18±44.20 ml)and incision length 6.85±1.12 cm in PFNA group were better than those in joint replacement group(P<0.05).However,weight bearing time(4.27±0.52 weeks)and latent blood loss(688.59±38.92 ml)in PFNA group were significantly higher than those in joint replacement group(P<0.05).(2)Functional score:The hip Harris score and Barthel ability of daily living score of the joint replacement group were higher than those of the PFNA group at 1,3 and 6 months after operation(P<0.05),but there was no significant difference between the two groups after 1 year(P>0.05).(3)Complications:The complication rate in the joint replacement group(20%)was significantly lower than that in the PFNA group(44.1%,P<0.05).(4)Delirium risk:Surgical method and occult blood loss were independent risk factors for postoperative delirium,and the area under the curve(AUC)of occult blood loss was 0.817(P<0.05),which had significant diagnostic value.Conclusion:(1)PFNA is predominant in surgical simplicity and trauma,while joint replacement is more advantageous in early functional recovery,reduction of delirium and complications;(2)Recessive blood loss is an important predictor of postoperative delirium,and clinical attention should be paid to it;(3)Joint replacement is an important complementary option for the treatment of unstable I

关 键 词：不稳定型股骨粗隆间骨折 肌骨近端防旋髓内钉 关节置换 隐性失血 术后谵妄 

分 类 号：R615[医药卫生—外科学]