髓内固定与髋关节置换治疗高龄逆转子间骨折的临床效果对比

目的对比髓内固定与髋关节置换治疗高龄逆转子间骨折使的临床疗效。方法回顾性分析2014年6月—2016年4月因逆转子间骨折于河南省许昌市中心医院行手术治疗的132例高龄患者,男性39例,女性93例;平均年龄81.36±7.8岁。根据手术方式分髋关节置换组(A组,72例)和股骨近端髓内钉(PFNA)组(B组,60例),对比两组患者手术时间、术中失血量、术后下地完全负重时间、住院时间、术后不同时间的Harris评分和相关并发症,随访6个月并观察两组患者的生活质量。结果 A、B组患者术前平均Hgb值差异均无统计学意义(P0.05),术后A组Hgb值为(82.49±6.52)g/L显著低于B组的(91.52±7.41)g/L(P0.05);B组平均手术时间为(67.23±6.42)min,明显少于A组的(82.12±8.56)min(P0.05),A组患者平均下地完全负重时间为(21.52±3.54)d,显著低于B组的(38.41±7.68)d(P0.05)。A组患者在术后2周和3个月Harris评分显著高于B组(P0.05),随访6个月,两组生理功能、生理职能、躯体疼痛、总体健康、精力活力、社会功能、情感职能和精神健康等各项评分比较差异均无统计学意义(P0.05),两组并发症比较差异无统计学意义(P0.05)。结论髓内固定对比髋关节置换治疗高龄逆转子间骨折早期临床效果相当,具有术中失血少、手术时间少的优点,更适合高龄逆转子间骨折患者。

Comparative research of clinical effect of intramedullary fixation and hip replacement in treating senile reverse obliquity intertrochanteric fractures

Objective To compare the clinical effects of the treatment of senile reverse obliquity intertro-chanteric fractures(ROIF) between intramedullary fixation and hip replacement .Methods Totally 132 elderly ROIF patients were retrospectively analyzed ,who were treated in our hospital from Jun .2014 to Apr.2016.There were 39 males and 93 females,with an average age of (81.36 ±7.18) years.Patients were divided into hip replace-ment group(group A,n=72) and proximal femoral nail antirotation (PFNA) group (group B,n=60) according to the methods of operation .The operation time , intraoperative blood loss , full weight-bearing time , length of hospital stay,postoperative Harris scores and related complications were recorded and compared between two groups .Re-sults The level of HgB after operation in group A was 82.49 ±6.52 g/L,which was lower than that in group B (91.52 ±7.41g/L,P<0.05).The operation time in group B ((67.23 ±6.42 ) min) was significantly less than that in group A ((82.12 ±8.56) min,P<0.05).The average time of the full weight-bearing was (21.52 ±3.54 ) d and (38.41 ±7.68)d in group A and B,respectively,which had significant difference (P<0.05).However,there was no difference among the scores of physical function ,body pain,general health,vitality,social function,emotion and mental health ( P >0.05 ) .Also, no statistical difference was observed in the complications between the two groups(P>0.05).Conclusion The clinical effects of the treatment of ROIF between intramedullary fixation and hip replacement are similar .However ,the intramedullary fixation is more suitable for the elderly ROIF patients due to its advantages such as less intraoperative blood loss and shorter operating time .