摘要
目的:比较人工全髋关节置换术(THA)与股骨近端防旋髓内钉(PFNA)内固定术治疗老年股骨粗隆间骨折患者的效果。方法:回顾性分析2021年1月至2024年1月该院收治的90例老年股骨粗隆间骨折患者的临床资料,按照术式不同将其分为内固定组与置换组各45例。置换组行THA治疗,内固定组行PFNA内固定术治疗。比较两组手术相关指标(术中出血量、术后下床活动时间、骨折愈合时间、手术时间)水平、生物力学指标(扭转1.5°时扭转刚度、扭转1.5°时扭转扭矩、荷载800 N时压缩刚度、荷载800 N时压缩位移)水平、术后不同时间髋关节功能[Harris髋关节功能评分法(HHS)]评分,以及并发症发生率。结果:置换组骨折愈合时间、住院时间、下床活动时间均短于内固定组,手术时间长于内固定组,术中出血量多于内固定组,差异有统计学意义(P<0.05);置换组扭转1.5°时扭转刚度、扭转1.5°时扭矩、荷载800 N时压缩刚度均大于内固定组,荷载800 N时压缩位移小于内固定组,差异有统计学意义(P<0.05);术后3、6个月,置换组HHS评分均高于内固定组,差异有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:THA治疗老年股骨粗隆间骨折患者可缩短骨折愈合时间、住院时间和下床活动时间,改善生物力学指标水平,提高髋关节功能评分,效果优于PFNA内固定术治疗,但会延长手术时间,增加术中出血量。
Objective:To compare effects of total hip arthroplasty(THA)and proximal femoral nail antirotation(PFNA)internal fixation in treatment of elderly patients with intertrochanteric fractures.Methods:The clinical data of 90 elderly patients with femoral intertrochanteric fractures admitted to this hospital from January 2021 to January 2024 were retrospectively analyzed.According to different surgical methods,they were divided into internal fixation group and replacement group,45 cases in each group.The replacement group was treated with THA,while the internal fixation group was treated with PFNA internal fixation.The levels of operation-related indexes(intraoperative blood loss,postoperative ambulation time,fracture healing time,operation time)and biomechanical indexes(torsional stiffness at 1.5°torsion,torsional torque at 1.5°torsion,compression stiffness at 800 N load,compression displacement at 800 N load),the hip function[Harris hip score(HHS)]scored at different time after the surgery,and the incidence of complications were compared between the two groups.Results:The fracture healing time,the hospitalization time and the ambulation time of the replacement group were shorter than those of the internal fixation group,the operation time was longer than that of the internal fixation group,the intraoperative blood loss was more than that of the internal fixation group,and the differences were statistically significant(P<0.05).The torsional stiffness at torsion of 1.5°,the torque at torsion of 1.5°,and the compression stiffness at load of 800 N in the replacement group were greater than those in the internal fixation group,the compression displacement at load of 800 N was less than that in the internal fixation group,and the differences were statistically significant(P<0.05).At 3 and 6 months after the surgery,the HHS scores of the replacement group were higher than those of the internal fixation group,and the differences were statistically significant(P<0.05).However,there was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusions:THA in the treatment of the elderly patients with femoral intertrochanteric fractures can shorten the fracture healing time,the hospitalization time and the ambulation time,improve the levels of biomechanical indexes,and improve the hip function scores.It is superior to PFNA internal fixation,but it will prolong the operation time and increase the intraoperative blood loss.
作者
裴万里
高凯旋
莫涛
PEI Wanli;GAO Kaixuan;MO Tao(Luoyang Third People’s Hospital,Emergency Surgery,Luoyang 471000 Henan,China;Luoyang Third People’s Hospital,Department of Orthopedics,Luoyang 471000 Henan,China)
出处
《中国民康医学》
2025年第20期146-148,共3页
Medical Journal of Chinese People’s Health
