摘要
目的对比股骨近端防旋转髓内钉(PFNA)、股骨头置换术治疗老年股骨转子间骨折的效果差异。方法回顾性分析2023年1月至2024年2月空军军医大学西京医院收治的210例老年股骨转子间骨折患者资料,根据手术方式,采用PFNA术者108例纳入A组,股骨头置换术者102例纳入B组,比较两组围术期指标、术后隐性失血量、髋关节功能(Harris髋关节评分系统)、骨代谢指标[抗酒石酸酸性磷酸酶5b(TRACP 5b)、骨钙素(OC)、Ⅰ型胶原C端肽(CTX-Ⅰ)]水平及术后不良事件发生率。结果与B组比较,A组手术时间短,术中出血、术后引流量少,下地负重及住院时间较长(P<0.05);A组术后1、3、7 d隐性失血量均少于B组(P<0.05);A组术后1、3个月Harris评分低于B组,术后12个月高于B组(P<0.05)。术后6个月,两组Harris评分比较,差异无统计学意义(P>0.05);A组术后1个月血清OC水平高于B组,血清TRACP 5b、CTX-Ⅰ水平低于B组(P<0.05);两组手术部位感染、肺部感染、尿路感染、下肢静脉血栓、髋关节脱位、髋部疼痛不良事件发生率比较,差异无统计学意义(P>0.05)。结论PFNA相较于股骨头置换术手术时间短且损伤小,可快速平衡机体骨代谢水平,患者远期髋功能恢复效果优,而股骨头置换术也具有卧床时间短且恢复快的优势。
Objective To compare differences in the curative effect of proximal femoral nail antirotation(PFNA)and femoral head replacement in the elderly patients with femoral intertrochanteric fractures.Methods A retrospective analysis was performed on the clinical data of 210 elderly patients with femoral intertrochanteric fractures at Air Force Medical University Xijing Hospital between January 2023 and February 2024.According to different surgical methods,108 patients undergoing PFNA were assigned in group A,while 102 patients undergoing femoral head replacement were assigned in group B.The perioperative indexes,postoperative hidden blood loss,hip function(Harris hip scoring system),levels of bone metabolism indexes[osteocalcin(OC),tartrate-resistant acid phosphatase 5b(TRACP 5b),C-terminal cross-linked peptide(CTX-I)and incidence of postoperative adverse events were compared between the two groups.Results Compared with group B,group A had shorter operation time,lower intraoperative blood loss,and lower postoperative drainage volume(P<0.05).Compared with group B,weight-bearing time and total hospitalization time were longer in group A(P<0.05).At 1d,3d and 7d after surgery,hidden blood loss in group A was less than that in group B(P<0.05).Hip Harris scores in group A were lower than those in group B at 1 month and 3 months after surgery,while they were higher than those in group B at 12 months after surgery(P<0.05).The difference in Harris score between the two groups was not statistically significant at 6 months after surgery(P>0.05).At 1 month after surgery,the level of serum OC in group A was higher than that in group B,while levels of serum TRACP 5b and CTX-I were lower than those in group B(P<0.05).The difference in incidence of adverse events(surgical site infection,lung infection,urinary tract infection,deep venous thrombosis,hip dislocation,hip pain)between the two groups was not statistically significant(P>0.05).Conclusion Compared with femoral head replacement,PFNA has shorter operation time and less trauma,promotes faster balance of bone metabolism levels,and achieves better long-term recovery of hip function.Femoral head replacement,whereas,offers advantages such as short bed-rest time and quick recovery.
作者
罗鸣
李岩
党海峰
赵轶男
樊俊俊
常宇坤
高子龙
高武才
卢利利
韩莉
LUO Ming;LI Yan;DANG Haifeng;ZHAO Yinan;FAN Junjun;CHANG Yukun;GAO Zilong;GAO Wucai;LU Lili;HAN Li(Department of Orthopedics,Air Force Medical University Xijing Hospital,Xi'an,Shaanxi 710032,China)
出处
《转化医学杂志》
2025年第6期52-56,共5页
Translational Medicine Journal
基金
陕西省科学技术厅计划项目(2021SF-178)。
关键词
股骨转子间骨折
老年
骨近端防旋转髓内钉
股骨头置换术
Femoral intertrochanteric fracture
Elderly
Proximal femoral nail antirotation
Femoral head replacement
