髋关节置换和股骨近端髓内钉治疗粗隆间骨折的临床研究

目的：探讨人工全髋关节置换术（totalhip arthroplasty,THA）与股骨近端钉（proximal femoral nail antirotation,PFNA）在老年股骨转子间骨折的临床疗效。方法：选取本院2009年2月-2012年2月收治住院的股骨转子间骨折老年患者200例,随机分为THA组100例与PFNA组100例。THA组采用人工全髋关节置换术治疗;PFNA组采用股骨近端钉内固定术治疗。观察并对比两组患者的临床指标如手术时间、术中出血量、术中X线透视次数、下床活动时间、并发症、住院天数等,采用MedliD’Aubigne评分方法评价髋关节功能。结果：两组患者的手术时间比较差异无统计学意义（P〉0.05）;THA组术中出血量较PFN组多,差异具有统计学意义（P〈0.05）;THA组患者术中X线透视次数、平均术后下床活动时间、平均住院时间、并发症发生率均较PFNA组低,差异具有统计学意义（P〈0.05）;THA组髋关节功能优良率比PFNA组高,差异具有统计学意义（P〈0.05）。结论：人工全髋关节置换是治疗高龄患者股骨转子间骨折的重要方法,具有良好的临床疗效。

The Clinical Observation of the Intertrochanteric Fracture Treat by Artificial Total Hip Arthroplasty and Proximal Femoral Nail

Objective：To discuss the clinical effect of the intertrochanteric fracture treated by artificial total hip arthroplasty（THA）and proximal femoral nail antirotation（PFNA）.Method：200 cases of intertrochanteric fracture in elderly patients from February 2009-February 2012 to our hospital were selected,who were randomly divided into experimental group（THA group）and control group（PFNA group）,100 cases in each group.THA group were treated with artificial total hip arthroplasty;PFNA group were treated with proximal femoral antirotation nail fixation.Observed and compared the clinical indicators such as operation time,intraoperative blood loss,intraoperative X-ray fluoroscopy times,ambulation time,complications, hospitalization days,etc of the two groups,and evaluate hip joint function by MedliD ’Aubigne grading.Result：The operation time of the two groups of patients had no significant difference（P 0.05）;THA loss more blood intraoperatie compared with PFN group,with significant difference（P 0.05）; THA group,s intraoperative X-ray perspective,the average number of leave bed activity time,average hospital stay,postoperative complication rates were relatively lower than those of the PFNA group,with significant difference（P 0.05）;THA group,s hip function was better than that of the PFNA group,with significant difference（P 0.05）.Conclusion：Artificial total hip arthroplasty are important in the treatment of elderly patient’s femoral intertrochanteric fracture,which has good clinical curative effect.