中国修复重建外科杂志

中国修复重建外科杂志

三种手术方式治疗老年股骨粗隆间骨折的疗效比较

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目的 比较股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)内固定、锁定加压接骨板(locking compression plate,LCP)内固定及人工股骨头置换术治疗老年股骨粗隆间骨折的疗效,为临床选择治疗方法提供参考。 方法 回顾性分析 2009 年 9 月—2016 年 4 月收治并符合选择标准的 150 例老年股骨粗隆间骨折患者临床资料,其中 51 例采用闭合复位 PFNA 内固定(A 组),53 例采用切开复位 LCP 内固定(B 组),46 例行人工股骨头置换术(C 组)。3 组患者性别、年龄、侧别、致伤原因、伤后至手术时间、骨折分型及合并内科疾病等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录并比较 3 组切口长度、手术时间、术中出血量、术后完全负重时间、手术相关并发症发生情况以及髋关节 Harris 评分。 结果 3 组患者均获随访;其中 A 组随访时间为 12~23 个月,平均 18.6 个月;B 组为 12~25 个月,平均 19.0 个月;C 组为 12~24 个月,平均 18.9 个月。A 组切口长度、手术时间、术中出血量均显著低于 B、C 组(P<0.05);C 组仅手术时间较 B 组缩短(P<0.05),切口长度及术中出血量比较差异无统计学意义(P>0.05)。但 C 组术后完全负重时间显著短于 A、B 组,A 组短于 B 组,比较差异均有统计学意义(P<0.05)。术后 A 组 11 例(21.6%)、B 组 14 例(26.4%)、C 组 2 例(4.3%)发生手术相关并发症;C 组手术相关并发症发生率显著低于 A、B 组(P<0.05),A、B 组间比较差异无统计学意义(P>0.05)。3 组患者术后 12 个月髋关节功能 Harris 评分比较,差异均无统计学意义(P>0.05)。 结论 PFNA、LCP 内固定及人工股骨头置换术均是治疗老年股骨粗隆间骨折的有效方法;但三者相比,PFNA 内固定具有创伤小、手术时间短、术中出血量少、操作简便的优势,而人工股骨头置换术后患者能早期负重、缩短卧床时间,降低了并发症发生风险。因此,对于此类患者建议选择 PFNA 内固定或人工股骨头置换术为宜。

Objective To compare the efficacy of proximal femoral nail anti-rotation (PFNA), locking compression plate (LCP), and artificial femoral head replacement for femoral intertrochanteric fracture in aged patients so as to provide reference for clinical treatment. Methods A retrospective analysis was made on the clinical data of 150 aged patients with femoral intratrochanteric fracture treated between September 2009 and April 2016. PFNA was used in 51 cases (group A), LCP in 53 cases (group B), and artificial femoral head replacement in 46 cases (group C). There was no significant difference in sex, age, side, cause of injury, injury to operation time, type of fracture, and combined medical diseases between groups (P>0.05). The incision length, operation time, intraoperative blood loss, time for full weight bearing, hip Harris score, and complications were recorded and compared between groups. Results The patients were followed up 12-23 months (mean, 18.6 months) in group A, 12-25 months (mean, 19.0 months) in group B, and 12-24 months (mean, 18.9 months) in group C. The incision length, operation time, and intraoperative blood loss of group A were significantly shorter than those of groups B and C (P<0.05); the operation time of group C was significantly shorter than that of group B (P<0.05), but there was no significant difference in incision length and intraoperative blood loss (P>0.05). The time for full weight bearing was significantly shorter in group C than groups A and B, and in group A than group B (P<0.05). Postoperative complications occurred in 11 patients of group A (21.6%), 14 patients of group B (26.4%), and 2 patients of group C (4.3%), showing significant difference between group C and group A or group B (P<0.05), but no significant difference was found between groups A and B (P>0.05). Hip Harris score at 12 months after operation had no significant difference between groups (P>0.05). Conclusion PFNA, LCP, and artificial femoral head replacement are all effective methods to treat femoral intertrochaniteric fracture in aged patients. PFNA has the advantages of small incision, short operation time, less bleeding and simple procedure, and artificial femoral head replacement has the advantages of early time for full weight bearing, less bed rest time, and less complications. For these patients, PFNA and artificial femoral head replacement are appropriate.

关键词: 股骨粗隆间骨折; 锁定加压接骨板; 股骨近端防旋髓内钉; 人工股骨头置换术; 老年患者

Key words: Femoral intertrochanteric fracture; proximal femoral nail anti-rotation; locking compression plate; artificial femoral head replacement; aged patients

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