高龄股骨粗隆间骨折半髋关节置换与股骨髓内钉治疗临床比较研究

目的观察半髋关节置换与防旋型股骨近端髓内钉内固定治疗高龄患者股骨粗隆间骨折的临床效果。方法笔者2011年3月~2013年8月使用半髋置换术及防旋型股骨近端髓内钉治疗高龄股骨粗隆间骨折39例,其中男性17例,女性22例;年龄70~93岁,平均(75.9±4.7)岁。患者经过长达1年以上的随访,回顾性分析两组的手术时间、术后卧床时间、住院时间、术后1年内的髋关节功能、手术出血量、术后引流量及并发症。结果半髋关节置换组在手术时间、术后卧床时间、住院时间及术后1年内的髋关节功能方面均优于防旋型股骨近端髓内钉组,差异有统计学意义(P0.05)。防旋型股骨近端髓内钉组手术出血量及术后引流量方面均优于半髋关节置换组,差异有统计学意义(P0.05)。两组在并发症方面未见明显差异(P0.05)。结论半髋置换和防旋型股骨近端髓内钉均适用于高龄股骨粗隆间骨折,均获得了较为满意的疗效,两者具有不同的优缺点,临床中应该按照个体化的原则进行治疗。

Study between hemiarthroplasty and proximal femoral nail anti-rotation for senile patients with intertrochanteric fracture

Objective To compare the clinical efficacy between hemiarthroplasty and femoral nail anti-rota-tion(PFNA)for senile patients with intertrochanteric fracture.Methods Totally 39 cases of senile intertrochanteric fracture from Mar.2011 to Aug.2013 were performed hemiarthroplasty and PFNA.Seveteen were male and 22 were female with an average age of (75.9 ±4.7)years (70-93 year).All patients had been followed-up for more than one year.Retrospective analysis was carried out about the therapeutic effect of the two groups.Results Hemiar-throplasty group had better results than PFNA group in operation time,postoperative bed time,hospitalization time and Harris score(P<0.05).The PFNA group excelled than the hemiarthroplasty group in operation bleeding vol-ume and postoperative drainage volume( P<0.05) .There was no significant difference between the two groups in complications(P>0.05).Conclusion Hemiarthroplasty and PFNA are both suitable for intertrochanteric fracture among the elderly people.Both have advantages and disadvantages.Clinical treatment should follow the principle of individualization.