股骨近端防旋髓内钉治疗老年骨质疏松性粗隆间骨折的临床效果

陈润彬 陈兴恺 吴廷换

[摘要]目的 研究股骨近端防旋髓内钉（PFNA）治疗老年骨质疏松性粗隆间骨折的可行性及安全性。方法 回顾性分析我院2015年1月～2017年1月收治的老年骨质疏松性粗隆间骨折患者167例，根据患者选择不同的手术方式分为实验组和对照组。实验组89例，采用PFNA内固定，对照组78例，采用关节置换术。比较两组手术时间、术中术后出血量、住院时间、术后Harris评分及术后并发症的发生率。结果 实验组手术时间短于对照组，术中出血量少于对照组，但住院时间、负重时间均长于对照组，差异均有统计学意义（P<0.05）；实验组术后Harris评分均高于对照组，术后关节脱位率、深静脉血栓率、肺部感染率均低于对照组，差异均有统计学意义（P<0.05）。结论 PFNA治疗老年骨质疏松性粗隆间骨折不仅有较好的疗效，而且并发症较少，值得在临床推广应用。

[关键词]股骨近端防旋髓内钉；老年骨质疏松；股骨粗隆间骨折；关节置换术

[中图分类号] R681.8 [文献标识码] A [文章编号] 1674-4721（2018）9（a）-0103-03

[Abstract] Objective To study the feasibility and safety of proximal femoral nail anti-rotation （PFNA） in the treatment of osteoporotic intertrochanteric fractures in the elderly patients. Methods 167 elderly patients with osteoporotic intertrochanteric fractures who were admitted to our hospital from January 2015 to January 2017 was retrospectively analyzed. The patients were divided into experimental group and control group according to different surgical methods. 89 patients in the experimental group were given PFNA internal fixation. 78 patients in the control group were given joint replacement. The operation time， intraoperative and postoperative blood loss， length of hospital stay， postoperative Harris score， and postoperative complication indence were compared between the two groups. Results In the experimental group， the operation time was shorter than those in the control group and intraoperative blood was losser than those in the control group. However， the length of hospital stay and weight-bearing time were longer than those in the control group， and the differences were statistically significant （P<0.05）； Harris scores in the experimental group were higher than those in the control group. The rate of postoperative joint dislocation， deep vein thrombosis， and pulmonary infection rate were lower in the experimental group than those in the control group. The differences were statistically significant （P<0.05）. Conclusion PFNA not only has a good curative effect but also has fewer complications in the treatment of elderly osteoporotic intertrochanteric fractures. It is worthy of clinical promotion.

[Key words] Proximal femoral nail anti-rotation； Elderly osteoporosis； Intertrochanteric fractures； Joint replacement

作為老年人常见骨折类型，股骨粗隆间骨折用保守治疗致死率达35%，故现多数学者认为老年骨质疏松性粗隆间骨折应尽早手术治疗[1]。目前手术治疗股骨粗隆间骨折的方法有股骨近端防旋髓内钉（PNFA）、Grama钉、空心钉、动力髋螺钉（DHS）、人工股骨头置换术等，但其疗效仍存在争议[2]。为进一步探究PFNA治疗老年骨质疏松性粗隆间骨折的可行性及安全性，进行了本试验研究，现报道如下。

1资料与方法

1.1一般资料

回顾性分析我院2015年1月～2017年1月收治的老年骨质疏松性粗隆间骨折患者167例，按患者选择不同的手术方式分为实验组和对照组。实验组89例，其中男49例，女40例；年龄68～83岁，平均（73.0±10.3）岁；骨折按改良Evans分类：ⅠB型18例，ⅡA型35例，ⅡB型22例，Ⅲ型14例；高血压26例，冠心病19例，糖尿病23例，其中同时合并两种或两种以上疾病者21例。……