PFNA和人工股骨头置换治疗老年股骨粗隆间骨折的疗效分析

目的探讨股骨近端防旋髓内钉(PFNA)和关节置换治疗老年人股骨粗隆间骨折的临床疗效。方法回顾性分析2005年10月～2009年6月收治的31例60岁以上老年不稳定型股骨粗隆间骨折患者进行PFNA和关节置换治疗的临床资料。其中按Evans分型,Ⅰ型7例,Ⅱ型11例,ⅢA型8例,ⅢB型3例,Ⅳ型2例。结果本组31例病人出院后均得到随访,随访时间为1～4年,平均15个月。全部患者均获得一期骨性愈合,愈合时间为3个月～8个月,平均时间为4.2个月。根据髋关节功能按Harris进行评定法,对两组髋关节功能进行评分。髋关节置换组91.8±6.1,PFNA治疗组96.3±8.1,两组的Harris评分差异无统计学意义(P>0.05)。结论人工股骨头置换和PFNA治疗股骨粗隆间骨折优点突出,只要选择好适应证均能取得良好的效果。

Efficacy of PFNA and Artificial Femoral Head Replacement for Treatment of Senile Intertrochanteric Femoral Fractures

Objective To discuss the clinical efficacy of proximal femoral nail anti-rotation(PFNA) and joint replacement for treatment of senile intertrochanteric femoral fractures.Methods Retrospectively analyzing the clinical data of 31 cases of over 60 year-old patients with unstable intertrochanteric fractures from October 2005 to June 2009,who were treated with PFNA and joint replacement.Evans classification showed typeⅠ in 7 cases,type Ⅱin 11 cases,type ⅢA in 8 cases,typeⅢB in 3 cases,typeⅣ in 2 cases.Results 31 patients were followed up after discharge,follow-up time was 1 to 4 years,with an average of 15 months.All patients received a first phase of bone healing,healing time was 3 months to 8 months,with an average of 4.2 months.According to Harris hip scores,the hip joint function scores of the two groups were assessed with total hip replacement group:91.8 ±6.1,PFNA treatment group:96.3 ±8.1.The Harris scores between the two groups had not statistically significant difference(P >0.05).Conclusion Both artificial femoral head replacement and PFNA for the treatment of intertrochanteric femoral fractures have obvious advantages,which can achieve good results if choosing appropriate indications.