两种方法治疗 Evans Ic 型股骨粗隆间骨折的疗效比较

摘要

目的：比较人工股骨头置换术与股骨近端防旋髓内钉（ proximal femoral nail antirotation，PFNA）治疗高龄Evans Ic 型股骨粗隆间骨折患者的临床效果。方法2010年1月至2012年7月间，我院共收治45例高龄 Evans Ic 型股骨粗隆间骨折患者，按照治疗方法分为 PFNA 组与人工股骨头置换手术组，其中 PFNA 组21例，人工股骨头置换组24例。术后将两组患者的手术时间、术中出血量、术后负重时间、术后并发症发生率以及术后3个月、12个月患髋Harris 评分进行对比分析。结果有43例患者得到随访，2例失访，平均随访时间16.1个月。PFNA 内固定失败患者3例，后改用人工股骨头置换术治疗。在手术时间、术中出血量方面，PFNA 组低于关节置换组，差异有统计学意义（P＜0.05）；术后早期下床时间及术后3个月髋关节 Harris 评分方面人工股骨头置换组优于 PFNA 组，差异有统计学意义（P ＜0.05）；两组间术后1年髋关节 Harris 评分以及术后并发症发生率比较，差异无统计学意义（P ＞0.05）。结论对于高龄Evans Ic 型股骨粗隆间骨折应首选PFNA 固定，但对于严重骨质疏松或内固定失败患者应采用人工股骨头置换术。%Objective To compare treatment effects between artificial femoral head replacement and proximal femoral nail anti_rotation(PFNA)in the elderly Evans type Ic femoral intertrochanteric fractures. Methods From January 2010 to July 2012,there were 48 elderly patients who had suffered from Evans type Ic femoral intertrochanteric fractures,which were retro_spectively analyzed based on operative management. PFNA for 21 cases and artificial femoral head replacement for 24 cases. The clinical results of the 2 groups were documented and compared in the followed aspects:operation time,blood loss during operation,load bearing time,incidence rates of complications and the Harris hip score of 3 and 12 months after operation. Re_sults There were 43 patients got follow_up,2 cases were lost,with average follow_up time was 16. 1 months. There were 3 pa_tients who failed with PFNA internal fixation were treated with artificial femoral head replacement. Follow_ups showed that PF_NA group was superior to artificial femoral head replacement group in the operation duration and the blood loss during operation (P < 0. 05),and inferior to artificial femoral head replacement group in the load bearing time and the Harris hip score at the time 3 months after operation(P < 0. 05),There were no significant difference in the incidence rates of complications and the Harris hip score at the time 12 months between two groups(P > 0. 05). Conclusion PFNA can be preferred to apply in the elderly Evans Ic femoral intertrochanteric fractures,but to severe osteoporosis or internal fixation failure,the artificial femoral head replacement is better.