老年不稳定股骨粗隆间骨折行人工股骨头置换与髓内固定的疗效对比

Comparative Efficacy of Artificial Femoral Head Replacement versus Intramedullary Fixation in Elderly Patients with Unstable Intertrochanteric Fractures

摘要: 目的：比较人工股骨头置换术与股骨近端防旋髓内钉内固定术在老年不稳定股骨粗隆间骨折患者中的疗效。方法：回顾性分析青岛市市立医院医院骨关节外科于2020年7月至2023年7月行手术治疗的98例老年不稳定股骨粗隆间骨折患者的病例资料，根据手术方式分为人工股骨头置换组48例与股骨近端防旋髓内钉内固定组50例。随访收集并分析比较两组的围术期指标、术后并发症发生率及功能预后数据。结果：两组患者基线特征差异无统计学意义(P > 0.05)，具有可比性。置换组的手术时间、术中出血量及术后输血率均显著高于内固定组(P < 0.05)，术后白蛋白水平下降幅度显著低于内固定组(P < 0.05)，术后首次负重时间显著早于内固定组(P < 0.001)。术后第1、3、6个月，置换组Harris髋关节评分显著优于内固定组(P < 0.05)，至术后12个月时两组评分无显著差异(P > 0.05)。术后第1、3个月，置换组VAS疼痛评分显著低于内固定组(P < 0.05)，术后6、12个月时两组疼痛评分无显著差异(P > 0.05)。两组术后并发症总发生率无显著差异(P > 0.05)，但内固定组内固定松动发生率略高(4% vs. 0%)。结论：股骨近端防旋髓内钉内固定术适用于合并贫血、凝血功能障碍或全身状况较差的患者。人工股骨头置换术适用于合并严重骨质疏松或内固定失败高风险者，以及需快速恢复生活自理能力的患者。

Abstract: Objective: To compare the clinical outcomes of artificial femoral head replacement (AFHR) versus proximal femoral nail antirotation (PFNA) internal fixation in elderly patients with unstable intertrochanteric fractures. Methods: We retrospectively analyzed 98 elderly patients with unstable intertrochanteric fractures treated surgically in the Department of Orthopedics at Qingdao Municipal Hospital between July 2020 and July 2023. Participants were divided into the AFHR group (n = 48) and PFNA group (n = 50) based on surgical approach. Perioperative parameters, postoperative complications, and functional outcomes were compared through follow-up assessments. Results: No significant differences in baseline characteristics were observed between groups (P > 0.05). The AFHR group demonstrated significantly longer operative time, greater intraoperative blood loss, and higher postoperative transfusion rates compared to the PFNA group (P < 0.05). However, the AFHR group showed smaller postoperative albumin level reductions (P < 0.05) and earlier postoperative weight-bearing initiation (P < 0.001). Harris Hip Scores were significantly superior in the AFHR group at 1, 3, and 6 months postoperatively (P < 0.05), with no intergroup difference at 12 months (P > 0.05). Visual Analog Scale (VAS) pain scores were significantly lower in the AFHR group during the initial 3 postoperative months (P < 0.05), with comparable scores between groups at 6 and 12 months (P > 0.05). While overall complication rates showed no significant difference (P > 0.05), the PFNA group exhibited a higher incidence of internal fixation loosening (4% vs. 0%). Conclusion: PFNA fixation is preferable for patients with anemia, coagulation disorders, or compromised systemic conditions. AFHR is recommended for patients with severe osteoporosis, high risk of fixation failure, or those requiring rapid recovery of independent mobility.