PFN钉置入内固定与人工股骨头置换治疗高龄股骨转子间骨折的比较

背景：PFN钉置入内固定用于治疗高龄股骨转子间骨折已被广泛应用于临床。但人工关节置换是否可以运用于高龄股骨转子骨折患者仍存在争议。 目的：比较PFN钉置入内固定与人工股骨头置换治疗高龄股骨转子间骨折疗效的差异 方法：选择青海省藏医院骨科高龄股骨转子间骨折患者62例，年龄75~87岁，按治疗方式随机分为PFN钉内固定组、人工股骨头置换组，二组均采用常规手术入路。观察2组患者的手术时间、出血量及髋关节功能、内科并发症等指标。 结果与结论：62例高龄股骨转子间骨折患者经切开复位内固定均获得成功。①两组手术时间差异无显著性意义(P > 0.05)。②人工股骨头置换组术中出血量多于PFN组、术后卧床时间、内科并发症及髋部畸形率均少于PFN组(P < 0.05)。人工股骨头置换组术后髋关节Harris评分优于PFN钉内固定组。人工股骨头置换因手术手术创伤较大出血量多，但在术后恢复时间、预防术后内科并发症及髋部畸形方面优于PFN钉内固定组，近期髋关节活动度要优于PFN钉内固定组。

Proximal femoral nail versus hemiarthroplasty for senile intertrochanteric fractures

BACKGROUND:Proximal femoral nail (PFN) internal fixation has been widely used for the treatment of intertrochanteric fractures in senile patients and has a good therapeutic effect. However, it is still controversial that whether artificial joint replacement can be used in intertrochanteric fractures in senile patients. OBJECTIVE:To investigate the clinical effect of PFN internal fixation versus hemiarthroplasty in intertrochanteric fractures of senile patients. METHODS:Sixty-two senile patients with intertrochanteric fractures were selected from Department of Orthopedics at Tibetan Medicine Hospital, the age of patients was from 75 years old to 87 years old. All patients were randomly divided into PFN groups (PFNG) and hemiarthroplasty groups (HEMG), and received operative treatment with common operative route. Operative time, bloodless volume, function of hip joint and complication were compared between PFNG and HEMG groups. RESULTS AND CONCLUSION:All operations of open reduction and internal fixation to intertrochanteric fractures in 62 cases of patients succeeded. ①Operative time was not remarkably different between PFNG and HEMG (P > 0.05). ②Bleeding volume, blood transfusion volume and time of getting out of bed was different (P < 0.05), which showed that operation wound was bigger in HEMG, but time of postoperative recovery was preponderant to PFNG. ③Incidence rate of medical complications and deformities of the hip joint was different between PFNG and HEMG, which showed that HEMG was preponderant to PFNG in preventing postoperative medical complications and deformities of the hip joint. ④Harris score showed activity of hip joint in the near future in HEMG was preponderant to that in PFNG.