PFNA与THA治疗老年不稳定型股骨粗隆间骨折疗效比较

发布时间：2019-02-17 10:20

【摘要】：目的:从手术操作时长、术中出血总量、术后并发症情况及术后下地活动时间,以及术后Harris评分等方面,把防旋股骨近端髓内钉(PFNA)和人工全髋关节置换(THA)治疗老年不稳定型股骨粗隆间骨折进行临床疗效上的比较,讨论两种术式治疗老年不稳定型股骨粗隆间骨折的适应症,分析两种手术方式与股骨粗隆间骨折分型的关系,为老年不稳定型股骨粗隆间骨折选择何种术式最佳提供了理论依据。方法:对2012年1月-2016年1月在武汉市武东医院外科住院的78例老年不稳定型股骨粗隆间骨折患者分别采用防旋股骨近端髓内钉(PFNA)30例和人工全髋关节置换术(THA)治疗48例进行了回顾性分析,其中女性患者32例,男性患者46例,年龄介于67岁至89岁之间,平均年龄76.54岁。Evans分型,Ⅲ型30例、Ⅳ型39例,V型9例。术前准备5至7天,对移位严重或有嵌插的骨折,行患侧胫骨结节骨牵引术。分组:A组(PFNA):30例,其中13例为女性患者、男性患者有17例,年龄67至83岁,平均年龄73.46岁;B组(THA):48例,其中19例为女性患者、男性患者为29例,年龄69至89岁,平均年龄79.62岁。对手术操作时长、术中出血总量、术后并发症情况及术后下地活动时间,以及术后Harris评分结果进行临床疗效统计分析。结果:本组78例患者中,67例患者积极配合随访,且随访资料完整可靠,总随访率达到85.90%;其中A组26例,随访率为86.67%;B组41例,随访率为85.42%。术后两组都没有发生手术切口感染。术中出血总量、手术操作时长、术后并发症情况、术后下地时间均有统计学意义(P0.05),术后1个月,3个月,6个月Harris评分统计结果无显著差异。结论:经过统计软件统计学分析后,术中出血总量、手术操作时长、术后并发症情况、术后下地时间均有统计学意义,术后1个月,3个月,6个月Harris评分统计结果无显著差异。PFNA具有手术操作时长短、术中切口较小、术中出血总量少的优点;人工全髋关节置换术具有术后并发症少、下地活动时间早的优点,两组资料在术后6个月随访中Harris评分无显著差异,证明PFNA和THA在治疗老年不稳定型股骨粗隆间骨折时均有效。对于PFNA来说,完全可以通过微创实现创伤小、出血少、对患者打击小的优点,可作为此类骨折首选治疗方法。而患者骨质疏松非常严重时,内固定植入后稳定性不可靠时,可考虑行THA;或者内固定术失败的病例,翻修手术很难获得稳定性时,THA可以作为一种补救措施;骨折的同时合并股骨头缺血坏死或退行性骨关节炎时,THA可以同时解决骨折和原发病两个问题。实际情况,应根据患者的各方面进行评估后选择最适宜的手术方式。
[Abstract]:Objective: to study the duration of operation, the total amount of bleeding during operation, the postoperative complications, the time of postoperative floor movement, and the postoperative Harris score, etc. The clinical effects of (PFNA) and total hip replacement (THA) in the treatment of unstable intertrochanteric fractures of the femur were compared, and the indications for the treatment of unstable intertrochanteric fractures in the elderly were discussed. The relationship between the two surgical methods and the classification of femoral intertrochanteric fracture was analyzed, which provided a theoretical basis for the selection of the best operative method for unstable femoral intertrochanteric fracture in the elderly. Methods: from January 2012 to January 2016, 78 elderly patients with unstable intertrochanteric fracture of femur were treated with (PFNA) and total hip replacement, respectively. A retrospective analysis was made of 48 cases treated with (THA). There were 32 female patients and 46 male patients, aged between 67 and 89 years, with an average age of 76.54 years. According to Evans classification, there were 30 cases of type 鈪，

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