【摘要】 目的回顾分析老年骨质疏松性不稳定型股骨转子间骨折的人工股骨头置换、股骨近端髓内钉(PFNA)内固定的疗效。方法 66例股骨骨质疏松性转子间粉碎骨折的老年患者分别行骨水泥型人工股骨头置换31例和PFNA内固定35例,比较两组平均手术时间、围手术期平均出血量、平均患肢完全负重时间,Harris髋关节功能评分。术后随访12~27个月,平均21个月。结果人工股骨头置换组平均手术时间(60±16)min,围手术期平均出血量500ml,平均患肢完全负重时间6d。Harris髋关节功能评分:优28例,良3例,差0例;优良率100%,平均住院费用(38846±5329.6)元。PFNA组平均手术时间(79±13)min,围手术期平均出血量514ml,平均患肢完全负重时间32d。Harris髋关节功能评分:优25例,良6例,差4例;优良率88.6%,平均住院费用(36126±6316.6)元。手术时间、平均负重时间、Harris评分两组间比较有显著差异(P<0.05)。围手术期出血量和平均住院费用比较无显著差异(P>0.01)。结论两种方式均能很好地治疗不稳定型股骨转子间骨折,但人工股骨头在术后髋部疼痛缓解、早期下床、功能锻炼方面具有明显的优势。更多还原

【Abstract】 Objective To retrospectively analyze the efficacy between artificial femoral head replacement and internal fixation with PFNA in the treatment of osteoporotic unstable femoral intertrochanteric fracture. Methods There were 66 elderly patients with osteoporotic unstable femoral intertrochanteric fracture. Totally 31 cases accepted artificial femoral head replacement with bone cement and 35 cases accepted internal fixation with PFNA. The average operative time,average perioperative blood loss,the average time to full weight-bearing and Harris hip score in two groups were compared. All patients were followed up for 12 to 27 months,with an average of 21 months. Results In artificial femoral head replacement group,the average operation time was( 60 ± 16) min,the average blood loss amount during operation was 500 ml and the average weight-bearing time was 6 days. According to Harris score,28 cases were excellent( 90. 3%) and 3 cases were good( 9. 7%). The average hospitalization expense was( 38846 ±5329. 6) yuan. In PFNA group,the average operation time was( 79 ± 13) min. The average blood loss amount during operation was 514 ml and the average weight-bearing time was 32 days in PFNA group. According to Harris score,the patients with PFNA internal fixation were excellent in 27 cases( 77. 1%),good in 7 cases( 20. 0%) and poor in1 case( 2. 9%). The average hospitalization expense was( 36126 ± 6316. 6) yuan in PFNA group. There was significant difference( P < 0. 05) in average operation time,average weight-bearing time and Harris score between two groups. The average bleeding and the average hospitalization expense showed no significant difference( P > 0. 05).Conclusion Both ways are effective for the treatment of unstable femoral intertrochanteric fracture. Artificial femoral head replacement has obvious advantages on pain relief,early ambulation and functional exercise after operation.更多还原