股骨近端防旋髓内钉内固定与人工股骨头置换治疗高龄不稳定型股骨粗隆间骨折疗效分析

摘要

Objective To discuss the efficacy of PFNA internal fixation and artificial femoral head replacement in elderly patients with unstable intertrochanteric fracture .Methods 96 elderly patients with unstable intertrochan‐teric fracture in our hospital from Sep .2011 to Mar .2013 were selected and divided into the control group and the observation group ,48 cases in each group .The observation group was given the artificial femoral head replacement , while the the control group ,was given the PFNA internal fixation .The clinical effects were compared between the two groups .Results The operative time and intraoperative bleeding volume had no statistical differences between the two groups(P>0 .05);the in‐bed time in the observation group was obviously shorter than that of the control group , with statistical difference (P<0 .05) .In the Harris hip joint function assessment ,the observation group had 34 cases (70 .83% ) of excellence ,which were more than 22 cases(45 .83% ) in the control group ,the difference between them had statistical significance (P< 0 .05);moreover the Harris score 1 year after operation in the observation group [(84 .9 ± 13 .4) points] was significantly higher than that in the control group[(73 .2 ± 14 .5)points] ,the difference between them was statistically significant (P<0 .05) .The total occurrence rate of complications in the observation group (8 .33% ) was obviously lower than that in the control group (31 .25% ) ,the difference between the two groups had statistical significance (P<0 .05) .Conclusion The artificial femoral head arthroplasty could have much better effect in treating elderly unstable intertrochanteric fracture than PFNA internal fixation and deserves to be promoted in clinic .%目的：探讨股骨近端防旋髓内钉（PFNA ）内固定与人工股骨头置换治疗高龄不稳定型股骨粗隆间骨折的疗效。方法选取2011年9月至2013年3月于海南省农垦总医院接受诊治的高龄不稳定型股骨粗隆间骨折患者96例，分为观察组和对照组，各48例。观察组患者给予人工股骨头置换，对照组患者给予PFNA内固定，比较两组患者的临床疗效。结果观察组与对照组患者手术时间及术中出血量比较差异均无统计学意义（P＞0．05）；观察组患者卧床时间比对照组短，组间比较差异有统计学意义（P＜0．05）。观察组患者 Harris髋关节功能评定为优的患者34例（70．83％），多于对照组的22例（45．83％），组间比较差异有统计学意义（ P＜0．05）；观察组患者术后1年Harris评分[（84．9±13．4）分]高于对照组[（73．2±14．5）分]，组间比较差异有统计学意义（P＜0．05）。观察组患者并发症的总发生率（8．33％）低于对照组（31．25％），组间比较差异有统计学意义（ P＜0．05）。结论人工股骨头置换治疗高龄不稳定型股骨粗隆间骨折的疗效比PFNA内固定更好，值得在临床中推广应用。