摘要
目的比较人工股骨头置换术(AFHR)与防旋型股骨近端髓内钉(PFNA)治疗EvansⅠ型老年股骨粗隆间骨折的临床效果。方法前瞻性研究2016年12月—2018年1月新疆医科大学第一附属医院创伤科收治EvansⅠ型老年股骨粗隆间骨折101例,按照手术方法不同将患者分为AFHR组(n=50,采用AFHR术式)和PFNA组(n=51,采用PFNA术式)。比较两组的临床疗效、髋关节功能恢复情况、临床相关指标,观察并比较两组术后并发症。结果两组临床疗效(86.0%vs.80.4%)比较差异无统计学意义(χ2=0.567,P=0.451)。PFNA组手术时间(53.2±20.4)min、切口长度(5.0±0.9)cm均短于AFHR组的(67.2±16.2)min、(13.2±1.1)cm,术中出血量(123.4±42.2)mL少于AFHR组的(198.2±54.4)mL;而AFHR组平均住院时间(14.3±2.5)d短于PFNA组的(18.5±3.3)d,下床活动时间(6.1±1.5)d早于PFNA组的(15.2±2.0)d(t=3.839,19.741,7.729,7.291,18.299;均P<0.001);术后3个月,AFHR组髋关节功能Harris评分(79.4±10.5)分优于PFNA组的(66.2±11.5)分(P<0.05),而术后6、12个月AFHR组髋关节功能Harris评分(83.7±9.5)分、(87.5±11.0)分与PFNA组(82.4±12.0)分、(86.5±13.4)分比较差异无统计学意义(P>0.05);术后3个月内随访,两组患者术后并发症发生率(6.0%vs.7.8%)比较差异无统计学意义(P>0.05)。结论AFHR和PFNA均能有效治疗EvansⅠ型股骨粗隆间骨折,PFNA具有术中出血量少、切口小、手术时间短等优点,而AFHR可减少患者平均住院时间、促进早期负重锻炼等,因此,临床治疗需综合考虑患者病情、骨折情况等因素以选择合适的手术方式。
Objective To compare the clinical effects of artificial femoral head replacement(AFHR)and proximal femoral intramedullary nailing with anti-rotation(PFNA)in the treatment of EvansⅠtype of femoral intertrochanteric fracture in the elderly.Methods Totally 101 elderly patients with EvansⅠtype of femoral intertrochanteric fracture admitted to our hospital from Dec.2016 to Jan.2018 were selected as the study subjects.Patients were divided into AFHR group(n=50,using AFHR)and PFNA group(n=51,using PFNA)according to the method of operation.The clinical efficacy,hip function recovery and clinical related indicator of the two groups were compared,and the postoperative complication of the two groups was observed and compared.Results There was no significant difference in clinical efficacy(86.0%vs.80.4%)between the two groups(χ2=0.567,P=0.451).The operation time(53.2±20.4)min,incision length(5.0±0.9)cm in PFNA group were shorter than those in AFHR group of(67.2±16.2)min,(13.2±1.1)cm,and the amount of bleeding during operation(123.4±42.2)mL was less than that in AFHR group of(198.2±54.4)mL.The average hospitalization time(14.3±2.5)d in AFHR group was shorter than that in PFNA group of(18.5±3.3)d,and the time of getting out of bed(6.1±1.5)d was earlier than that in PFNA group of(15.2±2.0)d(t=3.839,19.741,7.729,7.291,18.299;all P<0.001).3 months after operation,the Harris score(79.4±10.5)of AFHR group was better than that of PFNA group of(66.2±11.5)(P<0.05),but there was no significant difference in Harris score between AFHR group and PFNA group at 6 months and 12 months after operation of(83.7±9.5),(87.5±11.0)with(82.4±12.0),(86.5±13.4)(P>0.05).Within 3 months after follow-up,there was no significant difference in the incidence of postoperative complications(6.0%vs.7.8%)between the two groups(P>0.05).Conclusion Both AFHR and PFNA can effectively treat EvansⅠtype of femoral intertrochanteric fracture.PFNA has the advantages of less bleeding,less incision and shorter operation time.AFHR can reduce the average length of hospital stay,carry out early weight-bearing exercise and reduce the risk of complications after operation.Therefore,clinical treatment needs to take into account the patient s condition,fracture and other factors in order to select the appropriate surgical treatment.
作者
卜建文
吕云云
BU Jian-wen;LV Yun-yun(Department of Traumatology,First Affiliated Hospital of Xinjiang Medical University,Urumqi 831100,China)
出处
《创伤外科杂志》
2020年第1期42-45,共4页
Journal of Traumatic Surgery
基金
新疆维吾尔自治区自然科学基金(2016D01C1626)
关键词
股骨粗隆间骨折
股骨头置换
髓内钉
老年
femoral intertrochanteric fracture
femoral head replacement
intramedullary nailing
elderly
