骨质疏松性股骨粗隆间骨折的手术方式比较

摘要

Objective To compare and analyze the clinical effect of proximal femoral nail antirotation (PFNA) and hip arthroplasty (HA) in the treatment of osteoporotic intertrochanteric fracture.Methods In total 73 cases of elderly patients with intertrochanteric fracture treated in our hospital from December 2015 to January 2013 were retrospective analyzed.They were divided into PFNA group (39 cases) and HA group (34 cases) according to the surgical methods.The operation time,blood loss,time of hospitalization,ambulation time,and Harris score of postoperative hip function and complications of the two groups were compared.Results The amount of bleeding (116.89 ± 23.12 mL) and operation time (75.36 ± 14.18 min) in the PFNA group were significantly less than that of the HA group (362.57 ± 136.41 mL,97.85 ± 19.76 min),but the postoperative ambulation time (17.38 ± 2.13 d) was significantly longer than that of the HA group (8.65 ± 1.63 d),the differences were statistically significant (t =-4.863,-2.532,9.914;P =0.001,0.030,0.000,respectively).Harris score results showed that the excellent rate of hip joint function was not significantly different between the two groups (x2 =0.562,P =0.454).There was no significant differences in the incidence of complications after operation between the two groups (Z =4.037,P =0.372).Conclusion PFNA internal fixation in the treatment of osteoporotic intertrochanteric fracture has obvious advantages in shortening operation time and the control of bleeding amount.Ambulation time of HA is shorter,which is beneficial to patient recovery.Clinicians should choose appropriate treatment options according to the patient's age,physical condition,fracture type and degree of injury,etc.%目的 比较分析股骨近端髓内钉内固定(proximal femoral nail-rotation,PFNA)和人工髋关节置换术(hip arthroplasty,HA)治疗骨质疏松性粗隆间骨折的临床疗效.方法 回顾性分析2013年1月至2015年12月在我院骨科治疗的73例骨质疏松性老年股骨粗隆间骨折患者,按照手术方法不同分为PFNA组39例和HA组34例,比较两组患者的手术操作时间、术中出血量、住院时间、术后下地时间等指标以及术后12月髋关节功能Harris评分与并发症发生情况.结果 PFNA组的术中出血量(116.89 ±23.12 mL)、手术操作时间(75.36±14.18 min)明显少于HA组(362.57±136.41 mL,97.85±19.76 min),而术后下地时间(17.38±2.13 d)明显长于HA组(8.65±1.63 d),差异均有统计学意义(t=-4.863,-2.532,9.914;P =0.001,0.030,0.000).Harris评分结果显示,两组患者术后髋关节功能优良率无明显差异(x2=0.562,P=0.454).两组患者术后12个月的并发症发生情况无明显差异(Z =4.037,P=0.372).结论 PFNA内固定术治疗骨质疏松性股骨粗隆间骨折在缩短手术时间、控制出血量方面优势明显,HA术后下地时间较短,更利于患者恢复.临床医生应当根据患者在年龄、身体状况、骨折类型、损伤程度等情况选择适合的治疗方案.