生物型FHR与PFNA治疗高龄股骨粗隆间骨折疗效观察

发布时间：2018-08-27 10:40

【摘要】：[目的]探讨生物型人工股骨头置换(femoral head replacement,FHR)与股骨近端抗旋转髓内钉(proximal femoral nail anti-rotation,PFNA)治疗高龄股骨粗隆间骨折的临床疗效。[方法]2008年3月~2012年12月对108例高龄粗隆间骨折患者实施手术治疗。男63例,女45例;平均年龄83.72岁(75~99岁)。所有患者术前常规行骨密度检测,骨折均行Evens-Jensen分型,随机分为生物型FHR组47例及PFNA组61例。比较两组患者手术时间、出血量、下床时间、住院时间、Harris评分及深静脉血栓、肺部及泌尿系感染等情况。[结果]所有患者术后均获12~36个月随访,平均(28.04±6.32)个月。平均手术时间:PFNA组(53.73±15.22)min,FHR组(77.50±16.83)min,差异有统计学意义(P0.05)。平均术中出血量:PFNA组(132.51±33.21)ml,FHR组(286.34±43.23)ml,差异有统计学意义(P0.05)。术后下床锻炼时间:PFNA组平均(12.24±3.72)d,FHR组平均(3.12±1.23)d,差异有统计学意义(P0.05)。平均住院时间:PFNA组(7.60±1.83)d,FHR组(6.84±2.24)d,差异无统计学意义(P0.05)。术后1年髋关节功能Harris评分:PFNA组(87.71±7.92)分,FHR组(88.31±9.21)分,差异无统计学意义(P0.05)。术后并发症两组差异无统计学意义(P0.05)。[结论]FHR与PFNA是治疗高龄股骨粗隆间骨折安全有效的内固定方式,均可获得良好的髋关节功能,但应严格掌握手术适应证,合理选择最佳有效的手术方式。
[Abstract]:[objective] to investigate the clinical effect of biological artificial femoral head replacement (femoral head replacement,FHR) and proximal femoral anti rotating intramedullary nail (proximal femoral nail anti-rotation,PFNA) in the treatment of femoral intertrochanteric fracture in elderly patients. [methods] from March 2008 to December 2012, 108 elderly patients with intertrochanteric fracture were treated by operation. There were 63 males and 45 females with an average age of 83.72 years (75 ~ 99 years). Bone mineral density (BMD) was detected before operation and Evens-Jensen classification was performed in all patients. They were randomly divided into biotype FHR group (n = 47) and PFNA group (n = 61). The operative time, bleeding volume, time of getting out of bed, hospitalization time and Harris score, deep venous thrombosis, pulmonary and urinary tract infection were compared between the two groups. [results] all patients were followed up for 12 ~ 36 months (mean (28.04 卤6.32) months). The mean operative time was (53.73 卤15.22) min, in min,FHR group (77.50 卤16.83) min, (P0.05). The mean intraoperative blood loss was (132.51 卤33.21) ml,FHR (286.34 卤43.23) ml, (P0.05). The average time of getting out of bed after operation was (12.24 卤3.72) days in FHR group (3.12 卤1.23) days, the difference was statistically significant (P0.05). The average hospitalization time was (7.60 卤1.83) days in FHR group (6.84 卤2.24) days, there was no significant difference (P0.05). One year after operation, the score of Harris score of hip joint function in the Harris group was (87.71 卤7.92) and (88.31 卤9.21) in the FHR group, and there was no significant difference between the two groups (P0.05). There was no significant difference in postoperative complications between the two groups (P0.05). [conclusion] FHR and PFNA are safe and effective internal fixation methods for the treatment of intertrochanteric fracture of the femur in elderly patients. Both of them can obtain good hip joint function, but the indication of operation should be strictly grasped, and the best and effective operation method should be chosen reasonably.
【作者单位】：兰州军区兰州总医院骨科研究所关节外科;
【基金】：甘肃省科技计划项目(编号:1208RJZA108) 全军医药卫生基金课题(编号:CLZ12JAO7)
【分类号】：R687.3

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