目的：比较股骨近端防旋髓内钉（ PFNA）、人工双极股骨头置换术治疗老年股骨粗隆间骨折的临床疗效。方法回顾分析84例手术治疗老年股骨粗隆间骨折，其中男性39例，女性45例；年龄65～96岁，平均69.2岁。致伤原因：摔伤65例，高处坠落伤9例，道路交通伤及其他意外伤10例。其中，PFNA内固定治疗33例（ PFNA组），人工双极股骨头置换术51例（关节置换组）。比较两组手术时间、术中出血量、术中X线暴露次数、住院时间、Harris评分、髋关节功能和并发症发生率。结果 PFNA组在手术时间、术中出血量方面明显优于关节置换组（P＜0.05），术中X线暴露次数、住院时间方面，前者明显多于后者（P＜0.05）。关节置换组术后3个月内Harris评分明显优于PFNA组（P＜0.05），术后6个月两组髋关节功能与并发症发生率比较无显著差异（ P＞0.05）。结论两种手术方式各有利弊，术式选择上应根据患者自身状况及骨折类型决定。%Objective To compare the clinical efficacy of (proximal femoral nail anti-rotation, PFNA) and arthroplasty ( long-stem bipolar femur prosthetic replacement ) in the treatment of intertrochanteric fractures in elder-ly patients.Methods The clinical data of 84 elderly patients who suffered from intertrochanteric fracture and were treated by either PFNA or arthroplasty was retrospectively analyzed .There were 39 males and 45 females,with age ranging from 65 to 96 years(mean 69.2 years).There were 65 cases of falling injury,9 cases of high-falling injury, and 10 cases of road traffic injuries and other injuries .All the patients were randomly divided into PFNA group ( n=33) and arthroplasty group(n=51).The operative time,blood loss,X-ray exposure,hospital stay,Harris score,hip function and complication rate were compared between the two groups .Results The operative time and intraopera-tive blood loss in the PFNA group were better than those of the arthroplasty group (P<0.05),but the X-ray expo-sure frequency and length of hospitalization of the PFNA group were larger than those of the arthroplasty group ( P<0.05).The Harris score of the arthroplasty group was improved more greatly than the PFNA group (P<0.05)within 3 months after operation .There was no statistical difference in hip function and complications rate between the two groups at 6 months after operation ( P>0.05) .Conclusion The two kinds of operation modes have their own advan-tages and disadvantages ,and the surgical choice should be based on the patient's own condition and fracture type .
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