不同术式对老年股骨粗隆间骨折患者的疗效分析

Effect of Different Operative Methods on Elderly Patients with Femoral Intertrochanteric Fracture

摘要: 背景：随着医学发展，老年股骨粗隆间骨折患者的治疗经验日益成熟，但在手术方式的选择上仍存很大争议。目的：总结人工股骨头置换与PFNA治疗老年股骨粗隆间骨折的价值和意义，为临床医师提供选择。方法：按照纳排标准分析2018-01月~2019-12月武汉市中医医院收治的60例老年股骨粗隆间骨折患者的相关资料，包括观察组30例(关节置换)和对照组30例(PFNA内固定)，对其进行治疗和随访。记录并对比两组患者住院期间相关指标以及影像学资料。结果：两组随访时间为10~18个月，平均13.3 ± 2.76月。关节置换组术后复查X线假体位线和内固定组的骨折复位及内置物情况均令人满意。在手术时长、术区切口长度以及术中失血方面对照组较观察组更占优势(P < 0.05)。而总住院日对比来看观察组短于对照组(P < 0.05)。术后初次下地及完全负重时间观察组更早(P < 0.05)。术后输血率比较，内固定组输血率为23.3%，置换组为53.3%，P < 0.05。在后续的随访过程中，疼痛VAS评分方面两组均逐渐减少(P < 0.05)，并且Hariis评分逐渐增加(P < 0.05)。第1、4个月随访髋关节Harris评分观察组更优(P < 0.05)，末次随访时，Harris评分两组无统计学差异。VAS评分第1月随访时对照组更低(P < 0.05)，而在第4月及末次随访时无差异。随访期不良事件发生率情况，置换组发生率为13.3%，内固定组发生率为6.7%，差异无意义(P > 0.05)。结论：在治疗老年股骨粗隆间骨折的结果上人工股骨头置换与PFNA殊途同归，均可以使患者康复，但是在治疗特点上各有优势，PFNA具有手术时长短、术中失血少、微创等特点，而人工股骨头置换术治疗老年股骨粗隆间骨折在早期具有优势，有助于使患者更早恢复生活自理能力，符合ERAS相关理念，值得推广。

Abstract: Background: With the development of medicine, the treatment experience of elderly patients with femoral intertrochanteric fracture is becoming more and more mature, but there is still great con-troversy on the choice of surgical methods. Objective: To summarize the value and significance of artificial femoral head replacement and PFNA in the treatment of femoral intertrochanteric fracture in the elderly. Methods: The relevant data of 60 elderly patients with femoral intertrochanteric fracture treated in Wuhan Traditional Chinese Medicine Hospital from January 2018 to December 2019 were analyzed according to the Naxi standard, including 30 cases in the observation group (joint replacement) and 30 cases in the control group (PFNA internal fixation). The related indexes and imaging data of the two groups during hospitalization were recorded and compared. Results: The follow-up time of the two groups was 10~18 months, with an average of 13.3 ± 2.76 months. The X-ray prosthesis position line in the joint replacement group and the fracture reduction and inter-nal fixation in the internal fixation group were satisfactory. The control group was more dominant than the observation group in operation time, incision length and intraoperative blood loss (P < 0.05). The total length of stay in the observation group was shorter than that in the control group (P < 0.05). The time of initial descent and complete weight-bearing was earlier in the observation group (P < 0.05). The rate of postoperative blood transfusion was 23.3% in the internal fixation group and 53.3% in the replacement group (P < 0.05). During the follow-up, the VAS score of pain decreased gradually in both groups (P < 0.05), and the hariis score increased gradually (P < 0.05). The Harris score of hip joint in the observation group was better at the first and fourth months of follow-up (P < 0.05). At the last follow-up, there was no significant difference between the two groups. VAS score was lower in the control group at the first month follow-up (P < 0.05), but there was no difference at the fourth month and the last follow-up. The incidence of adverse events during the follow-up period was 13.3% in the replacement group and 6.7% in the internal fixation group. The difference was unintentional (P > 0.05). Conclusion: In the treatment of elderly femoral inter-trochanteric fractures, artificial femoral head replacement and PFNA have the same goal, which can make patients recover, but they have their own advantages in treatment characteristics. PFNA has the characteristics of long operation time, less intraoperative blood loss and minimally invasive, while artificial femoral head replacement has advantages in the early treatment of elderly femoral intertrochanteric fractures. It helps patients recover their self-care ability earlier, which is in line with the relevant concepts of eras and worthy of promotion.