【摘要】 目的 探讨高龄不稳定股骨转子间骨折患者应用股骨近端防旋髓内钉内固定术(proximal femoral anil antirotation, PFNA)和髋关节置换术的临床治疗效果。方法 选取76例高龄不稳定股骨转子间骨折患者为研究对象，PFNA组行股骨近端髓内钉内固定术(n=43),髋关节置换术组行髋关节置换术(n=33)。记录、分析两组患者手术时间、术中出血量、术后临床疗效(术后下床活动时间、术后负重时间、并发症发生情况)、住院时间、术前及术后血红蛋白(Hb)、血细胞比容(HCT)、视觉模拟评分(VAS)、Harris评分、健康调查量表(SF-36)评分。结果 所有参与研究的患者均完成了12～15个月随访，平均随访时长为(13.04±1.25)个月。髋关节置换术组患者手术时间、术中出血量、术后引流量多于PFNA组，术后下地活动时间、术后负重时间少于PFNA组(均P<0.05)。两组患者住院时间比较差异无统计学意义(P>0.05)。两组患者术前Hb、HCT比较差异无统计学意义(P>0.05);髋关节置换术组患者术后Hb、HCT水平低于PFNA组(P<0.001)。髋关节置换术组出现1例泌尿系感染、1例肺部感染和1例褥疮；PFNA组出现3例下肢深静脉血栓、2例泌尿系感染、4例肺部感染、3例褥疮以及1例脑梗死。无假体脱位、松动等并发症发生；髋关节置换术组术后并发症发生率低于PFNA组(P<0.05)。术前VAS、Harris评分两组比较差异无统计学意义(P>0.05)。术后1个月时，髋关节置换术组VAS评分低于PFNA组，Harris评分高于PFNA组(均P<0.01);术后6个月时，髋关节置换术组Harris评分高于PFNA组(P<0.01)。术前SF-36评分两组比较差异无统计学意义(P>0.05);术后6个月髋关节置换术组SF-36评分各项均高于PFNA组(P<0.01)。结论 PFNA与髋关节置换术均可有效治疗高龄不稳定股骨转子间骨折。髋关节置换术相较于PFNA能够更好地帮助患者尽早恢复下床活动，减少术后并发症，提升临床疗效。更多还原

【Abstract】 Objective To investigate the clinical therapeutic effect of applying proximal femoral anil antirotation(PFNA) and hip arthroplasty in elderly patients with unstable intertrochanteric femur fractures.Methods Seventy-six patients with unstable intertrochanteric femur fracture of advanced age were selected for the study, and internal fixation with intramedullary nailing of the proximal femur was performed in PFNA group(n=43),and hip arthroplasty was performed in hip arthroplasty group(n=33).The operation time, intraoperative bleeding, postoperative clinical outcomes(postoperative time out of bed, postoperative weight-bearing time, and the occurrence of complications),hospitalization time, preoperative and postoperative hemoglobin(Hb),hematocrit(HCT),visual analog score(VAS),Harris score, and health survey scale(SF-36) scores of patients in the two groups were recorded and analyzed.Results All patients who participated in the study completed 12 to 15 months of follow-up, and the average length of follow-up was(13.04±1.25) months.Patients in hip arthroplasty group had more operative time, intraoperative bleeding, and postoperative drainage than those in PFNA group, and their postoperative time to get down to the ground and postoperative weight-bearing time were shorter than those in PFNA group(all P<0.05).The difference in hospitalization time between the two groups was not statistically significant(P>0.05).There was no statistically significant difference in the comparison of preoperative Hb and HCT between the two groups(P>0.05).The postoperative Hb and HCT levels of patients in hip arthroplasty group were lower than those in PFNA group(P<0.001).In hip arthroplasty group, there was one case of urinary tract infection, one case of pulmonary infection and one case of decubitus ulcer.In PFNA group, there were three cases of lower extremity deep vein thrombosis, two cases of urinary tract infection, four cases of pulmonary infection, three cases of decubitus ulcer and one case of cerebral infarction.No complications such as dislocation and loosening of the prosthesis occurred.The incidence of postoperative complications in hip arthroplasty group was lower than that in PFNA group(P<0.05).There was no statistically significant difference between the two groups in preoperative VAS and Harris scores(P>0.05).At 1 month postoperatively, the VAS score of hip arthroplasty group was lower than that of PFNA group, and the Harris score was higher than that of PFNA group(both P<0.01).At 6 months postoperatively, the Harris score of hip arthroplasty group was higher than that of PFNA group(P<0.01).There was no statistically significant difference in preoperative SF-36 scores between the two groups(P>0.05).At 6 months postoperatively, SF-36 scores in hip arthroplasty group were higher than those in PFNA group in all cases(P<0.01).Conclusion Both PFNA and hip arthroplasty can effectively treat unstable intertrochanteric fractures in the elderly.Compared with PFNA,hip arthroplasty can better help patients to resume bed activities as soon as possible, reduce postoperative complications, and improve clinical efficacy.更多还原