PFNA和THA治疗老年性股骨粗隆间骨折的临床观察

目的探讨AO防旋型股骨近端髓内钉（PFNA）和全髋关节置换术（THA）在老年股骨粗隆间骨折治疗中的临床应用。方法将入选研究的238例老年性股骨粗隆间骨折患者随机分为对照组与试验组，每组各119例。对照组采用PFNA内同定术进行治疗，试验组采用THA进行治疗．观察两组患者的一般临床指标如住院时间、术中出血、手术时间、下床时间以及并发症发生情况，同时对两组患者进行随访，采用Kudema改良的Merli D’Aubigne评分系统对其髋关节功能恢复情况进行评价。结果两组患者手术时间和术中出血比较，差异无统计学意义（P〉0．05）。与对照组比较，试验组患者住院时间及下床时间均显著缩短（P〈0．05）；试验组患者术后并发症总发生率显著降低（P〈0．05），且随访发现其髋关节功能恢复优良率显著升高（P〈0．05）。结论THA是治疗老年性股骨粗隆间骨折的良好方法．效果显著优于PFNA内固定术。

Clinical observation of PFNA and THA in the treatment of intertrochanteric fractures of femur in elderly patients

Objective To explore application of proximal femoral nail anti-totation （PFNA） and total hip arthroplasty （THA） in the treatment of intertrochanteric fractures of femur in elderly patients. Methods 238 elderly patients with in- tertrochanteric fractures of femur were selected and divided into control group （n = 119） and experiment group （n = 119） evenly and randomly in this study. PFNA was applied in the control group, THA was applied in the experiment group. General indexes such as hospital stay time, surgery bleeding, surgery time, mobility recovery time and complication were observed and compared; condition of recovery of hip joint was assessed by Merli D＇Aubigne （Merli Modified） scoring sys- tem. Results The operation time and intraoperate bleeding of two groups were no significant difference （P 〉 0.05）; com- pared with control group, significantly shortened, hospital stay time and mobility recovery time （P 〈 0.05）; the incidence ratio of postoperative complications of experiment group was significantly reduced （P 〈 0.05）, significant increased fine ra- tio in assessment of hip joint recovery function was observed in the experiment group （P 〈 0.05）. Conclusion THA therapy is suitable in the treatment of intertrochanteric fractures of femur in elderly patients, significantly better than PFNA.