人工股骨头置换术与PFNA内固定术治疗不稳定粗隆间骨折的疗效比较(1)
摘要：目的 比較人工股骨头置换术与PFNA内固定术对老年不稳定性股骨粗隆间骨折的疗效。方法 回顾性分析2017年1月～2019年1月解放军联勤保障部队第九六七医院收治的76例老年不稳定性粗隆间骨折患者的临床资料，根据手术方式的不同分为PFNA组(40例)和置换组(36例)。PFNA组给予PFNA内固定术治疗，置换组给予人工股骨头置换术治疗，比较两组切口长度、手术时间、术中出血量、术后并发症发生情况及术后3、6、9个月髋关节优良率。结果 PFNA组切口长度、手术时间、术中出血量优于置换组，差异有统计学意义(P<0.05);PFNA组术后并发症总发生率为22.50%，高于置换组的5.56%，差异有统计学意义(P<0.05);置换组术后3、6个月髋关节优良率高于PFNA组，差异有统计学意义(P<0.05);术后9个月，两组髋关节优良率比较，差异无统计学意义(P>0.05)。结论 两种术式都是治疗老年不稳定粗隆间骨折的有效方法，人工股骨头置换术的优点在于术后早期下床、早期负重及功能锻炼，早期即可达到骨折部位的结构稳定，且并发症发生率低。PFNA内固定术优点为手术时间短，术中出血量少，对患者创伤小，利于患者术后恢复，但是术后并发症发生率高。手术选择应根据患者具体病情，合理选择手术方式。
关键词：老年不稳定粗隆间骨折;PFNA内固定术;人工股骨头置换术
中图分类号：R683.42 文献标识码：A DOI：10.3969/j.issn.1006-1959.2020.11.031
文章编号：1006-1959(2020)11-0104-03
Abstract：Objective To compare the effects of artificial femoral head replacement and PFNA internal fixation on elderly unstable intertrochanteric fractures.Methods Retrospectively analyze the clinical data of 76 elderly patients with unstable intertrochanteric fractures admitted to the 967th Hospital of the Joint Logistics Support Unit of the PLA from January 2017 to January 2019， and were divided into PFNA groups according to different surgical methods (40 cases) and replacement group (36 cases). The PFNA group was treated with PFNA internal fixation， and the replacement group was treated with artificial femoral head replacement. The incision length， operation time， intraoperative blood loss， postoperative complications and postoperative hips at 3， 6， and 9 months were compared between the two groups excellent rate of joints.Results The incision length， operation time， and intraoperative blood loss in the PFNA group were better than those in the replacement group，the difference was statistically significant (P<0.05); the total incidence of postoperative complications in the PFNA group was 22.50%， higher than 5.56% in the replacement group， the difference was statistically significant (P<0.05);The goodness rate of hip joints in the replacement group at 3 and 6 months after operation was higher than that in the PFNA group，the difference was statistically significant (P<0.05);at 9 months after operation， there was no statistically significant difference in hip joint goodness rate between the two groups(P>0.05).Conclusion Both procedures are effective methods for the treatment of unstable intertrochanteric fractures in the elderly. The advantages of artificial femoral head replacement are early post-operative bed， early weight-bearing and functional exercise. The structure of the fracture site is stable and complicated at the early stage. The incidence of the disease is low. The advantages of PFNA internal fixation are short operation time， less intraoperative blood loss， less trauma to the patient， which is beneficial to the patient's postoperative recovery， but the incidence of postoperative complications is high. The choice of surgery should be based on the patient's specific condition， and the surgical method should be reasonably selected., 百拇医药(李磊 岳勇 王继)
关键词：老年不稳定粗隆间骨折;PFNA内固定术;人工股骨头置换术
中图分类号：R683.42 文献标识码：A DOI：10.3969/j.issn.1006-1959.2020.11.031
文章编号：1006-1959(2020)11-0104-03
Abstract：Objective To compare the effects of artificial femoral head replacement and PFNA internal fixation on elderly unstable intertrochanteric fractures.Methods Retrospectively analyze the clinical data of 76 elderly patients with unstable intertrochanteric fractures admitted to the 967th Hospital of the Joint Logistics Support Unit of the PLA from January 2017 to January 2019， and were divided into PFNA groups according to different surgical methods (40 cases) and replacement group (36 cases). The PFNA group was treated with PFNA internal fixation， and the replacement group was treated with artificial femoral head replacement. The incision length， operation time， intraoperative blood loss， postoperative complications and postoperative hips at 3， 6， and 9 months were compared between the two groups excellent rate of joints.Results The incision length， operation time， and intraoperative blood loss in the PFNA group were better than those in the replacement group，the difference was statistically significant (P<0.05); the total incidence of postoperative complications in the PFNA group was 22.50%， higher than 5.56% in the replacement group， the difference was statistically significant (P<0.05);The goodness rate of hip joints in the replacement group at 3 and 6 months after operation was higher than that in the PFNA group，the difference was statistically significant (P<0.05);at 9 months after operation， there was no statistically significant difference in hip joint goodness rate between the two groups(P>0.05).Conclusion Both procedures are effective methods for the treatment of unstable intertrochanteric fractures in the elderly. The advantages of artificial femoral head replacement are early post-operative bed， early weight-bearing and functional exercise. The structure of the fracture site is stable and complicated at the early stage. The incidence of the disease is low. The advantages of PFNA internal fixation are short operation time， less intraoperative blood loss， less trauma to the patient， which is beneficial to the patient's postoperative recovery， but the incidence of postoperative complications is high. The choice of surgery should be based on the patient's specific condition， and the surgical method should be reasonably selected., 百拇医药(李磊 岳勇 王继)
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