股骨近端防旋髓内钉内固定术与人工股骨头置换术治疗股骨粗隆间骨折的效果对比  

Comparison of the therapeutic effect of proximal femoral nail antirotation intramedullary fixation and femoral head replacement on intertrochanteric femoral fractures

作　　者：张继锋[1] Zhang Jifeng(Department of Trauma Orthopedics,Puyang People’s Hospital,Puyang 457001,China)

机构地区：[1]濮阳市人民医院创伤骨科,濮阳457001

出　　处：《中国实用医刊》2025年第4期23-27,共5页Chinese Journal of Practical Medicine

摘　　要：目的比较股骨近端防旋髓内钉(PFNA)内固定术与人工股骨头置换术(FHR)治疗股骨粗隆间骨折(IFF)的效果。方法队列研究。抽取2021年1月至2023年12月濮阳市人民医院收治的采用FHR治疗的IFF患者80例作为FHR组,另抽取同期收治的采用PFNA内固定术患者80例作为PFNA组。比较两组患者手术指标、髋关节功能Harris评分、疼痛程度[视觉模拟评分法(VAS)]、髋关节功能恢复效果及并发症发生情况。结果PFNA组手术时间少于FHR组,术后下床活动时间及住院时间长于FHR组(P<0.05);PFNA组切口长度短于FHR组,手术出血量少于FHR组(P<0.05)。术后1、3、6个月,FHR组Harris评分均高于PFNA组(P均<0.05);术后3 d及术后1、2周,FHR组VAS评分均低于PFNA组(P均<0.05)。术后半年,FHR组髋关节功能优良率(93.75%,75/80)高于PFNA组(83.75%,67/80),P<0.05。两组并发症发生率比较差异未见统计学意义(P>0.05)。结论IFF患者治疗中,PFNA内固定术手术切口小,手术时间更短,可减少手术出血,但FHR有助于术后恢复,缩短康复时间,而且有助于更快减轻疼痛,促进髋关节功能更好地恢复。ObjectiveTo compare the value of the proximal femoral nail antirotation(PFNA)intramedullary fixation and femoral head replacement(FHR)in the treatment of intertrochanteric femoral fractures(IFF).MethodsFor the cohort study,80 patients with IFF treated by FHR in the Puyang People’s Hospital from January 2021 to December 2023 were selected as the FHR group,and 80 patients treated by PFNA internal fixation during the same period were selected as the PFNA group.The surgical indicators,hip joint function evaluated by Harris score,pain degree evaluated by visual analogue scale(VAS)score,the recovery effect of hip joint function and incidence of complications of the two groups were compared.ResultsThe PFNA group required shorter operation duration compared with the FHR group,while postoperative out-of-bed activity and hospital stay in the PFNA group were longer than those in the FHR group(P<0.05).The PFNA group had shorter incision length and less intraoperative blood loss compared with the FHR group(P<0.05).One,three and six months after operation,the Harris score of the FHR group was higher than that of the PFNA group(all P<0.05);3-day,1-week and 2-week postoperative VAS scores of the FHR group were lower than those of the PFNA group(all P<0.05).Six months after the operation,the excellent and good rate of hip function in the FHR group(93.75%,75/80)was higher than that in the PFNA group(83.75%,67/80),P<0.05.There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).ConclusionsIn the treatment of IFF patients,PFNA internal fixation surgery has a smaller incision and shorter operation duration,which can reduce surgical bleeding.However,FHR is conductive to postoperative recovery,shortening recovery time,reducing pain faster,promoting better recovery of hip joint function.

关 键 词：股骨粗隆间骨折 股骨近端防旋髓内钉内固定 人工股骨头置换 髋关节功能 疼痛 

分 类 号：R687.3[医药卫生—骨科学]