摘要
[目的]对比分析股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)与半髋关节置换(hemi⁃arthroplasty,HA)治疗老年不稳定粗隆间骨折的临床疗效。[方法]回顾性分析2014年1月至2018年12月本院收治的107例老年不稳定粗隆间骨折患者的临床资料,其中,61例采用PFNA,46例采用HA。比较两组患者围手术期、随访和影像资料。[结果]两组患者均顺利完成手术,两组患者术后早期并发症发生率差异无统计学意义(P>0.05)。PFNA组在手术时间、术中出血量和术后引流量均优于HA组(P<0.05)。HA组术后患肢恢复部分至完全负重时间显著早于PFNA组(P<0.05)。随时间推移,两组Harris评分均显著增加(P<0.05),术后1、6个月时,HA组髋关节Harris评分显著高于PFNA组,差异有统计学意义(P<0.05),但在术后12个月时两组间差异无统计学意义(P>0.05)。影像显示PFNA组并发症发生率显著高于HA组,差异有统计学意义(18.03%vs.4.35%,P<0.05)。[结论]PFNA与半髋关节置换均是治疗老年不稳定粗隆间骨折的安全、有效治疗方法,相比之下,一期行半髋关节置换的临床结果更优。
[Objective]To compare the clinical outcomes of proximal femoral nail anti-rotation(PFNA)versus hemiarthro⁃plasty(HA)for unstable intertrochanteric fractures in the elderly.[Methods]A retrospective study was conducted on 107 pa⁃tients who underwent surgical treatment for unstable intertrochanteric fractures from January 2014 to December 2018 in our de⁃partment.Among them,61 patients had open reduction and internal fixation with PFNA,whereas 46 patients received HA.The patients in the two groups were compared in perioperative,follow-up and radiographic documents.[Results]All the patients in both groups had operation performed with no significant difference in occurrence of early complication between the two groups(P>0.05).The PFNA group was significantly superior to the HA group regarding operation time,intraoperative blood loss and postoperative drainage(P<0.05).However,the HA group returned to the partial and full weight-bearing activities significantly earlier than the PFNA group(P<0.05).The Harris score significantly increased in both groups over time(P<0.05),which in the HA group was significantly higher than that in the PFNA group at 1 and 6 months postoperatively(P<0.05),and became not sta⁃tistically significant between them at 12 months after operation(P>0.05).The radiographic examination revealed that the later complication relative to implant in the PFNA group was significantly higher than the HA group(18.03%versus 4.35%,P<0.05).[Conclusion]Both PFNA and HA are safe and effective treatments for unstable intertrochanteric fractures in the elderly.By comparison,the HA provides better clinical outcomes than the PFNA.
作者
李安澜
曹翠香
仲海燕
邵为
曹华
陈步俊
王新国
王春秋
王俊
LI An-lan;CAO Cui-xiang;ZHONG Hai-yan;SHAO Wei;CAO Hua;CHEN Bu-jun;WANG Xin-guo;WANG Chun-qiu;WANG Jun(Department of Traumatic Orthopaedics,Zhenjiang Medical District,General Hospital of The PLA Eastern Theater,Zhenjiang212001,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2020年第22期2036-2040,共5页
Orthopedic Journal of China
关键词
老年人
股骨粗隆间骨折
股骨近端抗旋转髓内钉
半髋置换
elderly
femoral intertrochanteric fracture
proximal femoral nail anti-rotation(PFNA)
hemiarthroplasty(HA)
