3种手术方法治疗老年骨质疏松性髋部骨折的疗效及安全性对比  

Comparison of the Efficacy and Safety of Three Surgical Methods for Treating Senile Osteoporotic Hip Fractures

作　　者：王寅 李印鹏 郝明 李熙明[1] 曹斌 WANG Yin;LI Yinpeng;HAO Ming;LI Ximing;CAO Bin(Department of Trauma,Shijiazhuang People's Hospital,Shijiazhuang,Hebei 050000,China)

机构地区：[1]石家庄市人民医院创伤科,河北石家庄050000

出　　处：《转化医学杂志》2025年第3期96-102,共7页Translational Medicine Journal

基　　金：石家庄市科技计划项目(231460573)。

摘　　要：目的分析股骨近端防旋髓内钉固定(PFNA)、人工关节置换术与新型组合微创半髋置换术3种手术方法治疗老年骨质疏松性髋部骨折的疗效及安全性。方法选取2020年1月至2023年1月石家庄市人民医院收治的174例老年骨质疏松性髋部骨折患者临床资料,依据不同手术方法分为微创组(新型组合微创半髋置换术)、关节置换组(人工关节置换术)、内固定组(PFNA),每组58例。比较3组围术期指标、术后髋关节功能优良率、骨折恢复状况、人工全髋关节置换术Harris评分、Berg平衡量表评分(BBS)及术后并发症。结果微创组、内固定组手术时间、切口总长度、术中出血量、术后引流量均短于或少于关节置换组(P<0.05),但微创组与内固定组比较差异无统计学意义(P>0.05);微创组、内固定组住院时间、骨折愈合时间、术后下床活动时间均短于关节置换组(P<0.05),但微创组与内固定组比较差异无统计学意义(P>0.05);术后6个月、12个月微创组Harris评分、BBS评分均高于内固定组、关节置换组(P<0.05);术后6个月,微创组髋关节功能优良率(72.41%)高于关节置换组(51.72%)、内固定组(60.34%)(P<0.05),但关节置换组与内固定组比较差异无统计学意义(P>0.05);术后12个月,3组髋关节功能优良率比较,差异无统计学意义(P>0.05);微创组、内固定组术后并发症发生率(5.17%vs 10.34%)均低于关节置换组(24.14%)(P<0.05)。结论PFNA内固定、人工关节置换术与新型组合微创半髋置换术治疗,均能改善老年骨质疏松性髋部骨折患者髋关节功能,提高平衡能力,其中新型组合微创半髋置换术和PFNA内固定效果较好。Objective To analyze the efficacy and safety of three surgical methods for treating senile osteoporotic hip fractures:Proximal femoral nail antirotation(PFNA)internal fixation,artificial joint replacement,and a novel combined minimally invasive hemiarthroplasty.Methods Clinical data of 174 elderly patients with osteoporotic hip fractures in Shijiazhuang People's Hospital(2020.01-2023.01)were used as the research subjects.Patients were divided into the minimally invasive group(n=58,novel combined minimally invasive hemiarthroplasty),joint replacement group(n=58,artificial joint replacement),and internal fixation group(n=58,PFNA internal fixation)according to different surgical methods.The perioperative indicators,excellent and good rate of hip joint function,fracture recovery status,Harris score,Berg Balance Scale(BBS)score,and postoperative complications were compared among the three groups.Results The operation time,total incision length,intraoperative blood loss,and postoperative drainage volume in the minimally invasive group and internal fixation group were shorter or less than those in the joint replacement group(P<0.05),but there was no significant difference between the minimally invasive group and the internal fixation group(P>0.05).The hospitalization time,fracture healing time,and postoperative ambulation time in the minimally invasive group and internal fixation group were shorter than those in the joint replacement group(P<0.05),but there was no significant difference between the minimally invasive group and the internal fixation group(P>0.05).At 6 and 12 months post-surgery,the Harris score and BBS score in the minimally invasive group were higher than those in the internal fixation group and the joint replacement group(P<0.05).Six months post-surgery,the rate of excellent and good hip function in the minimally invasive group(72.41%)was higher than that in the joint replacement group(51.72%)and the internal fixation group(60.34%)(P<0.05).However,there was no significant difference between the joint r

关 键 词：人工关节置换术 近端防旋髓内钉固定术 微创半髋置换术 髋部骨折 髋关节功能 平衡状况 

分 类 号：R683.3[医药卫生—骨科学]