PFNA与人工股骨头置换术治疗老年不稳定型股骨粗隆间骨折的临床疗效分析

摘要

目的：探讨股骨近端防旋髓内钉（ PFNA）与人工股骨头置换术（ ATBA）治疗老年不稳定型股骨粗隆间骨折的疗效及安全性。方法回顾性分析笔者医院63例老年不稳定型股骨粗隆间骨折患者临床资料，其中35例采用PFNA治疗（ PFNA组），28例采用ATBA治疗（ ATBA组），比较两组患者平均手术时间、术中出血量、输血量、术后引流量、术后开始部分负重时间及末次随访Harris评分。结果 PFNA组平均手术时间、术中出血量、输血量、术后引流量、术后开始部分负重时间及末次随访Harris评分分别为（42．9±11．8）min、（84．2±27．5）mL、（85．3±20．6）mL、（65．3±21．6）mL、（28．7±10．3）d、（80．9±12．5）分；ATBA组分别为（101．1±18．7）min、（311．3±105．4）mL、（273．1±45．5）mL、（217．4±35．2）mL、（5．9±3．2）d、（77．2±14．1）分，PFNA组平均手术时间、术中出血量、输血量及术后引流量均显著少于ATBA组，组间比较差异具有统计学意义（ P＜0．05）；而PFNA组术后开始部分负重时间方面明显长于ATBA组，且组间比较差异具有统计学意义（P＜0．05）；PFNA组与ATBA组末次随访Harris评分比较，PFNA组高于ATBA组，且差异具有统计学意义（P＜0．05）。结论 PFNA可作为老年不稳定型股骨粗隆间骨折患者的首选治疗方式，但对于有早期下地负重需求的患者而言ATBA更为适宜。%Objective To evaluate the safety and efficacy of proximal femoral nail anti-rotation ( PFNA) and artificial thigh bone arthroplasty ( ATBA ) on old patients with unstable femoral intertrochanteric fracture . Methods The clinical data of 63 cases of elderly unstable femoral intertrochanteric fracture was retrospective ana-lyzed.Among them 35 cases were treated with PFNA (PFNA group),and the other 28 cases were treated with AT-BA (ATBA group).The average operation time,intraoperative blood loss,blood transfusion volume,postoperative drainage ,postoperative load time and Harris score of the last follow-up were compared between the two groups .Re-sults The average operation time ,intraoperative blood loss ,blood transfusion volume ,postoperative drainage ,postop-erative load time and Harris score of the last follow-up in PFNA group were (42.9 ±11.8) min,(84.2 ±27.5) mL, (85.3 ±20.6) mL,(65.3 ±21.6) mL,(28.7 ±10.3) d and (80.9 ±12.5) respectively,while those of ATBA group were(101.1 ±18.7)min,(311.3 ±105.4)mL,(273.1 ±45.5)mL,(217.4 ±35.2)mL,(5.9 ±3.2)d and (77.2 ±14.1) respectively.The average operation time,intraoperative blood loss,blood transfusion volume and postoperative drainage of PFNA group were significantly less than those of ATBA group , and showed significant differences(P<0.05).However,postoperative load time of ATBA group were significantly less than that of PFNA group(P<0.05).The Harris score of the last follow-up in PFNA group was significantly higher than that of ATBA group(P<0.05).Conclusion PFNA is the first treatment for old patients with unstable femoral intertrochanteric fracture and serious osteoporosis .But for patients with early load demand ,ATBA is more appropriate .