带粗隆长柄人工股骨头置换与股骨近端防旋髓内钉治疗老年粗隆间粉碎性骨折的疗效分析

目的 对比分析带粗隆长柄人工股骨头置换(hemiarthroplasty with tuberositas component,HTC)与股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)治疗老年粗隆间粉碎性骨折的临床疗效.方法 回顾分析本院2010年1月至2012年12月收治的65例老年粗隆间粉碎性骨折(AO/OAT分型为A2.3或A3型)患者的临床资料,采用HTC治疗的30例纳入HTC组,采用PFNA治疗的35例纳入PFNA组.比较两组的手术时间、术中失血量、输血量、术后引流量、下床时间、负重行走时间、住院时间以及术后1、6、12个月的Harris评分.结果 PFNA组术中失血量、输血量、术后引流量、住院时间均明显少于HTC组,差异有统计学意义(均P＜0.05);HTC组的下床时间和负重行走时间均早于PFNA组,差异有统计学意义(均P＜0.05);HTC组术后1个月的Harris评分高于PFNA组,差异有统计学意义(P＜0.05),但术后6、12个月的评分结果差异均无统计学意义(均P＞0.05).结论 HTC与PFNA在老年不稳定性粗隆间骨折的治疗中各有利弊,手术耐受力差的患者宜 ·使用PFNA;基础疾病少、手术耐受能力好的患者宜使用HTC.

Hemiarthroplasty with tuberositas component versus proximal femoral nail anti-rotation: A study for the treatment of unstable intertrochanteric fractures in the elderly patients.

Objective To compare the clinical efficacy of hemiarthroplasty with tuberositas component (HTC) vs. proximal femoral nail anti-rotation (PFNA) in the treatment of unstable intertrochanteric factures in the elderly patients. Methods A total of 65 patients with unstable intertrochanteric factures (A2.3 or A3 style AO/OAT classification) treated surgically with HTC (30 cases) or PFNA (35 cases) admitted from Jan. 2010 to Dec. 2012 were collected retrospectively. Operation time, intraoperative bleeding, volumn of blood transfusion, drainage volume, time to get off bed and weight bearing, hospital stay days and Harris hip joint function scores at 1st, 6th and 12th month after operation were assessed. Results The intraoperative bleeding, volume of blood transfusion, drainage volume and hospital stay days were significantly in PFNA group as compared with HTC group (P<0.05 for all). Time to get off bed and weight bearing was earlier in HTC group than in PFNA group. At 1st month after operation, Harris hip joint function scores in HTC group were significantly higher than in PFNA group (P<0.05), but there was no significant difference at 6th and 12th month after operation between two groups (P>0.05). Conclusion HTC and PFNA have their own advantages in the treatment of unstable intertrochanteric factures in the elderly patients. PFNA is recommended in the patients with poor surgical tolerance, and HTC is used in the patients with less basic diseases and better surgical tolerance.