两种人工关节置换术与股骨近端防旋型髓内钉治疗老年股骨转子间骨折的效果比较

Two kinds of artificial joint replacement versus proximal femoral anti-rotation intramedullary nail in treatment of elderly patients with femoral intertrochanteric fracture

  • 摘要:
      目的  比较生物型假体人工关节置换术、骨水泥型假体人工关节置换术与股骨近端防旋型髓内钉(PFNA)内固定治疗老年股骨转子间骨折患者的效果。
      方法  选取120例老年股骨转子间骨折患者作为研究对象,按照治疗方法的不同分为生物型组(采用生物型假体人工关节置换术治疗)29例、骨水泥型组(采用骨水泥型假体人工关节置换术治疗)30例和PFNA组(采用PFNA内固定治疗)61例,比较3组的治疗效果。
      结果  生物型组、骨水泥型组的术中出血量大于PFNA组,手术时间长于PFNA组,住院费用高于PFNA组,卧床时间、住院时间短于PFNA组,差异有统计学意义(P < 0.05)。术后1、6、12个月时,生物型组、骨水泥型组的视觉模拟评分法评分低于PFNA组,Harris评分高于PFNA组,差异有统计学意义(P < 0.05)。生物型组、骨水泥型组的临床疗效优良率高于PFNA组,差异有统计学意义(P < 0.05)。3组并发症发生率比较,差异无统计学意义(P>0.05)。
      结论  生物型假体人工关节置换术与骨水泥型假体人工关节置换术对老年股骨转子间骨折患者的临床疗效优于PFNA内固定治疗,但PFNA内固定治疗术中出血量小、手术时间短且治疗费用更低。

     

    Abstract:
      Objective  To compare the effects of biological prosthetic joint replacement, bone cement prosthetic joint replacement and proximal femoral anti-rotation intramedullary nail (PFNA) in the treatment of elderly patients with femoral intertrochanteric fracture.
      Methods  A total of 120 elderly patients with femoral intertrochanteric fracture were selected as research objects, and divided into biological group (given with biological prosthesis artificial joint replacement, 29 cases) and bone cement group (given bone cement prosthetic artificial joint replacement, 30 cases) and PFNA group (treated with PFNA, 61 cases) according to the different treatments. The treatment effects of the three groups were compared.
      Results  The amount of intraoperative blood loss in the biological group and the bone cement group was larger than that of the PFNA group, the operation time was longer than the PFNA group, the hospitalization cost was higher than the PFNA group, and the bed time and hospital stay were shorter than the PFNA group (P < 0.05). At 1 month, 6 and 12 months after surgery, the Visual Analogue Scale scores of the biological group and the bone cement group were lower than that of the PFNA group, and the Harris score was higher than that of the PFNA group (P < 0.05). The excellent and good rate of clinical efficacy in the biological group and the bone cement group was higher than that in the PFNA group (P < 0.05). There was no significant difference in the incidence of complications among three groups (P>0.05).
      Conclusion  Biological prosthetic joint replacement and bone cement prosthetic joint replacement have better clinical effects than PFNA treatment for elderly patients with femoral intertrochanteric fractures, but PFNA internal fixation therapy has less intraoperative blood loss, shorter operation time and lower treatment cost.

     

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