兩種術(shù)式治療高齡患者股骨轉(zhuǎn)子間骨折的療效分析

王森　石雯迪　張曉威

摘 要：目的 對比股骨近端防旋髓內(nèi)針術(shù)PFNA和人工股骨頭置換術(shù)兩種術(shù)式治療高齡患者股骨轉(zhuǎn)子間骨折的效果。方法 回顧分析承德醫(yī)學(xué)院附屬醫(yī)院于2014年4月～2017年4月收治的55例股骨轉(zhuǎn)子間骨折的患者，采用PFNA術(shù)患者35例為A組，股骨頭置換術(shù)患者20例B組，術(shù)后早期指導(dǎo)功能鍛煉。統(tǒng)計(jì)分析兩組患者手術(shù)時(shí)間，術(shù)中出血量，術(shù)后下地活動時(shí)間，住院天數(shù)，術(shù)后并發(fā)癥，術(shù)后1個(gè)月、5個(gè)月及9個(gè)月Harris評分及并發(fā)癥情況。結(jié)果 A組手術(shù)平均時(shí)間（96.03±14.01）min，平均術(shù)中出血量（104.29±17.87）ml，平均住院天數(shù)（12.97±4.28）d，術(shù)后1個(gè)月Harris評分（61.47±7.02）分，術(shù)后下地活動時(shí)間（10.49±1.63）d，B組手術(shù)平均時(shí)間（113.75±12.55）min，平均術(shù)中出血量（372.50±144.62）ml，平均住院天數(shù)（20.90±2.53）d，術(shù)后1個(gè)月Harris評分（74.26±9.31）分，術(shù)后下地活動時(shí)間（7.65±1.57）d，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；兩組術(shù)后5個(gè)月、9個(gè)月Harris評分及并發(fā)癥情況比較，差異均無統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論 采用PFNA治療高齡患者轉(zhuǎn)子間骨折手術(shù)時(shí)間短、固定穩(wěn)定且更符合股骨近端生物力學(xué)特性，術(shù)中出血量少，住院周期短，不增加術(shù)后并發(fā)癥。

關(guān)鍵詞：股骨轉(zhuǎn)子間骨折；高齡患者；人工股骨頭置換術(shù)；股骨近端防旋髓內(nèi)針

中圖分類號：R687.3 文獻(xiàn)標(biāo)識碼：A DOI：10.3969/j.issn.1006-1959.2018.22.027

文章編號：1006-1959（2018）22-0100-04

Therapeutic Effect of Two Surgical Treatments for Femoral Intertrochanteric Fractures in Elderly Patients

WANG Sen1，SHI Wen-di1，ZHANG Xiao-wei1，ZHANG Chun-yan1，GU Rui2，YANG Xiao-hua2

（1.Graduate School of Chengde Medical College，Chengde 067000，Hebei，China；

2.Department of Trauma and Orthopaedics，Affiliated Hospital of Chengde Medical College，Chengde067000，Hebei，China）

Abstract：Objective The effect of PFNA and artificial femoral head replacement on the treatment of femoral intertrochanteric fractures in elderly patients was compared with the treatment of proximal femoral condylar intramedullary acupuncture.Methods A retrospective analysis of 55 patients with femoral intertrochanteric fractures admitted to the Affiliated Hospital of Chengde Medical College from April 2014 to April 2017. 35 patients with PFNA were included in group A， and 20 patients in group B with femoral head replacement surgery. After the early guidance of functional exercise. The operation time， intraoperative blood loss， postoperative activity time， length of hospital stay， postoperative complications， Harris score and complications at 1 month， 5 months and 9 months after operation were analyzed statistically.Results The average time of surgery in group A was（96.03±14.01） min， the mean intraoperative blood loss was（104.29±17.87） ml，the average hospital stay （12.97±4.28）d， Harris score（61.47±7.02） 1 month after operation， postoperative activity time（10.49±1.63） d， group B： average operation time （113.75±12.55） min， The mean intraoperative blood loss （372.50±144.62） ml， the average hospital stay （20.90±2.53） d， the Harris score （74.26±9.31） 1 month after operation， and the postoperative activity time （7.65±1.57） d， the two groups were compared，the difference was statistically significant （P<0.05）. There was no significant difference in Harris score and complications between the two groups at 5 months and 9 months（P>0.05）. Conclusion The use of PFNA in the treatment of intertrochanteric fractures in elderly patients is short， stable and more consistent with the biomechanical properties of the proximal femur. The intraoperative blood loss is small， the hospitalization period is short， and the postoperative complications are not increased.

Key words：Femoral intertrochanteric fractures；Elderly patients；Artificial femoral head replacement；Proximal femoral anti-rotation intramedullary nail

股骨轉(zhuǎn)子間是指股骨干與股骨頸的交界處，該處主要為松質(zhì)骨且承受應(yīng)力最大，多數(shù)老年人骨質(zhì)疏松，隨著人口平均壽命的增加、老齡化加快及交通事故高發(fā)，故股骨轉(zhuǎn)子間骨折（intertrochanteric fractures of femur）臨床上多見于老年人且其發(fā)病率在逐年增高[1]。多數(shù)文獻(xiàn)報(bào)道老年患者傷前多合并各種內(nèi)科疾病，保守治療易發(fā)生諸多并發(fā)癥且病死率及致殘率明顯升高[2]。目前國內(nèi)外多數(shù)學(xué)者認(rèn)為轉(zhuǎn)子骨折患者在沒有明顯手術(shù)禁忌證時(shí)，應(yīng)積極手術(shù)治療，術(shù)后早期指導(dǎo)功能鍛煉、適宜時(shí)間下床活動，避免相關(guān)并發(fā)癥，可獲得較好生活質(zhì)量[3，4]。……