关节置换和股骨近端髓内钉治疗高龄股骨粗隆间骨折的疗效研究

摘要

目的 探讨人工股骨头置换术和股骨近端髓内钉系统(PFNA)内固定术治疗高龄患者股骨粗隆间骨折的临床疗效.方法 回顾性分析2010年12月至2014年12月我院收治的高龄股骨粗隆间骨折患者58例.比较2组患者的手术时间、术中出血量、术后引流量及关节功能评分等指标.结果 人工股骨头置换组手术时间少于PFNA组;术后1个月及1年随访关节功能Harris评分优于PFNA组;关节置换组术中出血总量及术后24 h引流量明显多于PFNA组.结论 2种手术方式均可达到满意治疗效果,PFNA内固定术多适用于合并基础疾病多、术中闭合骨折复位易达到满意效果、骨质疏松程度轻、手术创伤耐受性较差等患者.对于内科相关疾病相对较轻、复位及固定困难,严重骨质疏松、手术耐受性较好患者,选择关节置换术更佳.%Objective To determine the efficacy of cemented hemiprosthetic hip joint arthroplasty in comparison with proximal femoral nail antirotation (PFNA) applied to femoral intertrochanteric fracture in elderly patients.Methods This retrospective analysis consisted of 58 patients with intertrochanteric fracture who underwent cemented hemiprosthetic hip joint arthroplasty and PFNA who were admitted between January 2010 and December 2014 in No.202 Hospital of PLA.Their operative time,bleeding volume,postoperative drainage volume,and joint function scores were compared.Results The cemented hemiprosthetic hip joint arthroplasty group had shorter operative time than the PFNA group,but the PFNA group had better Harris scores for joint function in the first month after operation and the last follow-up.Intraoperative hemorrhage and postoperative drainage were exceedingly high in the PFNA group.Conclusion Both therapies can be used to manage intertrochanteric fracture in elderly patients effectively.PFNA is mostly applied in patients with more-basic defects,worse physical conditions,worse tolerance to surgeries,and lighter osteoporosis,whereas cemented hemiprosthetic hip joint arthroplasty is more suitable for patients with less severe physical defects,more severe osteoporosis,and better physical conditions.