大转子式股骨柄置换及股骨近端防旋髓内钉治疗老年股骨转子间骨折

摘要

目的 探讨大转子式股骨柄(GTF)双极股骨头置换及股骨近端防旋髓内钉(PFNA)治疗老年不稳定性股骨转子间骨折的临床疗效.方法 对34 例老年股骨转子间骨折患者分别采用GTF双极股骨头置换(GTF组,19例)和PFNA内固定治疗(PFNA组,15例),比较两组手术时间、出血量、住院天数、下床时间、术后并发症、髋关节功能Harris评分等指标.结果 34例均得到随访,时间6～48(12.7±5.8)个月.PFNA 组均获得骨性愈合.PFNA组手术时间、出血量低于GTF组,GTF组下床时间、并发症、早期Harris评分优于PFNA组,差异均有统计学意义(P<0.05);两组患者住院天数及中晚期Harris评分差异无统计学意义(P>0.05).结论 GTF柄双极股骨头置换与PFNA内固定治疗老年不稳定性股骨转子间骨折,均可获得满意的临床效果,在一定适应证范围内,GTF具有相应优势.%Objective To explore the curative effect of bipolar prosthetic replacement ( greater trochanter femoral stem, GTF ) and proximal femoral nail anti-rotation ( PFNA ) for treatment of senile patients with intertrochanteric fractures. Methods 34 elderly patients with intertrochanteric fractures were treated with GTF (19 cases ) and PFNA (15 cases ). The operation time, mean intraoperative blood loss, postoperative complications and the Harris hip function scores were observed. Results All patients were followed up for 6 to 48 months, 12. 7 ± 5. 8 months average. All patients in PFNA group were obtained complete union. The operative time and blood loss of PFNA group was significantly less than the GTF group( P <0. 05 ). The modified Harris hip score of the GTF group is superior to the PFNA group in early stage( P < 0. 05 ), but it is no different in middle and later stage between them( P > 0. 05 ), and it has advantages of allowing early weight-bearing,having low incidence of postoperative complication in the GTF group ( P <0. 05 ). Conclusions The methods of GTF and PFNA both have good clinic curative effect in treatment of intertrochanteric fractures of elder. GTF can be recommended to treat intertrochanteric fractures in the senile patients within a certain range of adaptation.