股骨近端防旋髓内针与人工关节置换治疗老年股骨转子间骨折对比分析

目的探讨股骨近端防旋髓内针(PFNA)及人工髋关节置换(半髋及全髋)治疗老年股骨转子间骨折疗效对比。方法笔者回顾分析2010年~2013年间分别予PFNA及人工髋关节置换治疗的126例老年股骨转子间骨折患者临床资料,其中男性57例,女性69例;年龄65~92岁,平均74.5岁。对比分析该两种手术方法创伤大小、术后并发症、关节功能等方面优缺点。结果 PFNA治疗组患者切口小、深部组织损伤小、手术出血少,但有防旋刀片切割股骨颈情况出现;人工髋关节置换组术后下床时间早,但有人工关节脱位、感染出现;两组术后早期关节功能恢复并无明显差异,但术后1年PFNA组优于髋关节置换组。结论 PFNA治疗老年转子间骨折优于髋关节置换,但患者适应证选择较为重要。

Comparison of proximal femoral nail antirotation and hip replacement in treating femoral intertrochanteric fracture in the elderly

Objective To explore the outcome of the proximal femoral nail antirotation( PFNA) internal fixation and hip replacement( total hip replacement or artificial thigh bone replacement) in treating femoral intertro-chanteric fracture in elderly patients.Methods Clinical data was retrospectively analyzed in 126 elderly patients with femoral intertrochanteric fracture who were treated by proximal femoral nail antirotation( PFNA) internal fixa-tion and hip replacement from 2010 to 2013.There was 57 males and 69 females,with an average age of 74.5 years (65-92 years).The advantages and disadvantages in the operation wound,postoperative complication and hip func-tion were compared between the two methods.Results PFNA had the advantages of small incision,mini-invasive trauma in the deep tissue and less blood loss,but some patients appeared with femoral neck screw cutout; patients with artificial hip replacement could leave the bed early but had the problems of hip joint dislocation and infection. There was no difference in early joint function between the two groups, but the joint function 1 year after operation in the PFNA group was better.Conclusion PFNA for treating intertrochanteric fracture in the elderly is better than hip replacement,but the indication selection is more important.