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股骨近端防旋髓内钉和人工股骨头置换治疗老年股骨转子间骨折的疗效比较

Effect of proximal femoral nail anti-rotation versus femoral head replacement for treatment of intertrochanteric fractures in the elderly

摘要:

目的 比较股骨近端防旋髓内钉(PFNA)与人工股骨头置换术(FHR)治疗老年股骨转子间骨折疗效的差异. 方法 回顾性分析2012年6月-2014年9月收治的69例老年股骨转子间骨折患者的临床资料,根据治疗方法分为PFNA组(41例)和FHR组(28例).PFNA组男17例,女24例;年龄80~101岁,平均86.7岁;受伤至手术时间(3.1±1.0)d.FHR组男13例,女15例;年龄80 ~99岁,平均87.2岁;受伤至手术时间(3.2±1.0)d.比较两组患者手术时间、术中出血量、术后输血量、术后下地时间、并发症发生率、术后3d血红蛋白(Hb)变化及术后6个月关节功能. 结果 患者均获随访1~3年,平均1.8年.PFNA组手术时间(46.8±4.4)min,少于FHR组的(57.4±5.9) min(P< 0.05),PFNA组术中出血量(77.0±24.2)ml,少于FHR组(150.7±46.5)ml(P<0.05).但PFNA组术后3 dHb比术前减少(21.3±6.1)g/L,而FHR组则为(23.2±5.8)g/L,二者差异无统计学意义(P>0.05).FHR组术后平均下地时间(3.2±1.2)d,较PFNA组的(7.1±2.5)d缩短(P<0.05).FHR组术后并发症发生率为14% (4/28),较PFNA组37%(15/41)降低(P<0.05).术后6个月两组髋关节功能差异无统计学意义(P>0.05),但FHR组髋关节功能优良率[82% (23/28)]高于PFNA组[73% (30/41)]. 结论 对于老年股骨转子间骨折,与PFNA比较,FHR治疗后患者并发症发生率更低,关节功能恢复更好,是老年严重骨质疏松患者的优先选择.

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abstracts:

Objective To examine the difference in the effectiveness between proximal femoral nail anti-rotation (PFNA) and femoral head replacement (FHR) of intertrochanteric fracture in elderly patients.Methods This study collected 69 patients that underwent PFNA or FHR after intertrochanteric fractures between June 2012 and September 2014.PFNA group was composed of 41 subjects (17 males and 24 females) aged 80-101 years (mean,86.7 years),and time from injury to operation was (3.12 ± 0.95)days.FHR group was composed of 28 subjects (13 males and 15 females) aged 80-99 years (mean,87.2 years),and time from injury to operation was (3.2 ± 1.0) days.Comparison of operation time,intraoperative blood loss,postoperative blood transfusion,off-bed time,complication incidence,hemoglobin concentration and hip function was made between groups.Results Duration of follow-up was 1-3 years (mean,1.8 years).Operation time and intraoperative blood loss in PFNA group were (46.8 ± 4.4) minutes and (77.0 ± 24.2) ml respectively,differed from (57.4 ± 5.9) minutes and (150.7 ± 46.5) ml in FHR group (P < 0.05).Three days after operation,a similar decrease in hemoglobin concentration was seen in PFNA group [(21.3 ±6.1)g/L] and FHR group [(23.2 ±5.8)g/L] (P > 0.05).Off-bed time in FHR group was (3.2 ± 1.2) days,shorter than (7.1-± 2.5) days in PFNA group (P < 0.05).Incidence of postoperative complications in FHR group was 14%,lower than 37% in PFNA group (P < 0.05).Hip function of the two groups presented no significant difference six months after operation,but the proportion of excellent results in FHR group was higher than that in PFNA group (82% vs.73%) (P > 0.05).Conclusion FHR provides better results over PFNA regarding off-bed time,complication incidence and hip function,and hence is preferred for the treatment of elderly patients with intertrochanteric fractures,especially in those with severe osteoporosis.

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