加长柄人工股骨头置换术与PFNA内固定治疗高龄不稳定股骨粗隆间骨折的比较研究

目的比较加长柄人工股骨头置换术与股骨近端防旋髓内钉(PFNA)治疗高龄不稳定股骨粗隆间骨折的临床效果。方法回顾性比较分析自2013-06—2014-09诊治的65例高龄不稳定股骨粗隆间骨折,采用PFNA内固定治疗20例(PFNA组),采用加长柄人工股骨头置换术治疗45例(其中骨水泥组22例,生物型组23例)。比较3组手术时间、术中出血量、术后下地时间、并发症发生率,以及术后1、3、6、12个月髋关节功能Harris评分。结果 65例均获得随访9~18个月,平均12个月。3组手术时间差异有统计学意义(P0.05),PFNA组少于生物型组和骨水泥组,而生物型组少于骨水泥组。3组术中出血量差异有统计学意义(P0.05),PFNA组少于生物型组和骨水泥组,而骨水泥组少于生物型组。3组术后下地时间差异有统计学意义(P0.05),生物型组和骨水泥组明显早于PFNA组,而骨水泥组早于生物型组。生物型组和骨水泥组术后1、3、6个月髋关节功能Harris评分均优于PFNA组,但生物型组与骨水泥组比较差异无统计学意义(P0.05);术后12个月时3组髋关节功能Harris评分差异无统计学意义(P0.05)。结论对于身体状况较好、骨质稳定的高龄股骨粗隆间骨折,可首选PFNA髓内固定;对于伴有严重骨质疏松,不适合内固定治疗以及内固定失败,或预期置换后关节使用年限不长患者,加长柄人工股骨头置换术是安全、有效的手术方式。

Comparative study of PFNA and long-stem hemiarthroplasty for unstable femoral intertrochanteric fractures in elderly patients

Objective To compare the clinical effects of proximal femoral nail antirotation (PFNA) and long-stem hemiarthroplasty in the treatment of unstable femoral intertrochanteric fractures in elderly patients.Methods From Jun.2013 to Sept.2014,a retrospective study was performed on sixty-five elderly patients with unstable femoral intertrochanteric fractures.Twenty patients were treated with PFNA fixation (PFNA group),while forty-five patients were treated with long-stem hemiarthroplasty (22 cases in cement prosthesis group,23 cases in cementless prosthesis group).The operative time,intraoperative blood loss,weight-bearing time after operation,postoperative complication rate,and Harris hip score of 1,3,6,12 months after surgery were compared among groups.Results All 65 cases were followed up.The average follow-up period was 12 months,ranging from 9 to 18 months.There was a significant difference in operative time among the three groups (P ＜ 0.05),the PFNA group was shorter than the long-stem hemiarthroplasty group,the cementless prosthesis group was shorter than the cement prosthesis group.There was a significant difference in intraoperative blood loss among the three groups(P ＜0.05),the PFNA group was less than the long-stem hemiarthroplasty group,the cement prosthesis group was less than the cementless prosthesis group.In terms of weight-bearing time after operation,there was a significant difference among the three groups (P ＜ 0.05),the long-stem hemiarthroplasty group was significantly earlier than the PFNA group,while the cement prosthesis group was earlier than the cementless prosthesis group.Harris hip scores of long-stem cementless prosthesis group and cement prosthesis group at 1,3,6 months after surgery were higher than that of the PFNA group,but the differences between cementless prosthesis group and cement prosthesis group were not statistically significant(P ＞0.05).In terms of Harris hip score,the differences were not statistically significant among the three groups at 12 months after operation(P ＞0.05).Conclusion For patients with good physical condition and bone stability,PFNA intramedullary fixation is a preferred choice;for elderly patients with severe osteoporosis,not suitable for internal fixation and internal fixation failure,or the patients with the joint life span of expectedly not long time after replacement,long-stem hemiarthroplasty is a safe and effective surgical approach.