【摘要】 目的探讨髋关节置换术(hip replacement,HR)与近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定术对老年股骨转子间骨折(intertrochanteric femoral fracture,IFF)患者功能恢复的效果比较。方法选取2013年6月至2016年6月我院收治的100例老年IFF患者,平均年龄(71.26±5.27)岁。按照入院顺序分为HR组和PFNA组,每组50例,观察和记录两组手术、下床、住院、负重锻炼时间和切口长度(其中PFNA组为主钉切口长度)、术中出血量、并发症等,随访12个月,评估术后6、12个月髋关节功能:(1)并发症:皮下血肿、切口感染、下肢深静脉血栓(deep vein thrombosis,DVT)、褥疮等;(2)髋关节功能:采用髋关节Harris评分进行评估,Cronbach’α信度系数为0.885,效度系数为0.848,采用人工计分法,共9个条目合计100分,得分越高表示髋关节功能恢复越良好。结果 PFNA组下床、住院、负重锻炼时间高于HR组,PFNA组切口长度、术中出血量、手术时间、并发症发生率低于HR组,差异有统计学意义(P均=0.000);PFNA组并发症发生率低于HR组,差异有统计学意义(P=0.028);HR组术后6个月髋关节功能优良率明显高于PFNA组,差异有统计学意义(P=0.032),HR组和PFNA组术后12个月髋关节功能优良率基本相同,差异无统计学意义(P=0.901)。结论 HR有利于老年IFF患者早期活动和髋关节功能恢复,PFNA内固定术有利于减少患者手术创伤和并发症,但两种术式均具有良好的远期髋关节功能恢复效果,应按临床需求选择。更多还原

【Abstract】 Objective To discuss the comparison effects of the hip replacement( HR) and proximal femoral nail anti-rotation( PFNA) fixation on the functional recovery in elderly patients with intertrochanteric femoral fracture( IFF). Methods A total of 100 elderly patients with IFF were selected from June 2013 to June 2016 in our Hospital. The average age was( 71.26 ± 5.27) years. According to the treatment method, all patients were divided into the HR group( n = 50) and PFNA group( n = 50). HR group was given HR treatment, while PFNA group was given PFNA treatment. Results The immobilization, hospital stay, weight-bearing exercise time of the PFNA group were significantly better than those of the HR group; and the incision length, intraoperative blood loss, operating time of PFNA group were significantly lower than those of the HR group with statistically significant differences( all P = 0.000). The complication rate of PFNA group was significantly lower than that of the HR group with statistically significant differences( P = 0.028). The hip function excellent rate of the HR group 6 months postoperatively was significantly higher than those of the PFNA group with statistically significant differences( P = 0.032). 12 months postoperatively, hip function excellent rates of the HR group and PFNA group were basically the same with no statistically significant differences( P = 0.901). Conclusions HR is beneficial to the early activity and hip functional recovery in elderly patients with IFF. PFNA fixation is beneficial to reduce surgical trauma and complications. Both of them have good long-term hip functional recovery effects, so that clinical demand should be considered accordingly.更多还原