PFNA内固定术与人工股骨头置换术治疗高龄不稳定型股骨粗隆间骨折的效果分析

谢百羽

【摘要】 目的：探討高龄不稳定型股骨粗隆间骨折患者行PFNA内固定术或人工股骨头置换术治疗的效果。方法：选择2016年4月-2019年4月笔者所在医院收治的78例高龄不稳定型股骨粗隆间骨折患者，随机分为两组，各39例，观察组行人工股骨头置换术，对照组行PFNA内固定术，评价两组手术指标、恢复效果及并发症。结果：观察组手术时间长于对照组，术中出血量及术后引流量均多于对照组，下地负重行走时间早于对照组，住院时间及骨折愈合时间均短于对照组，差异均有统计学意义（P<0.05）;观察组并发症发生率为8.51%，低于对照组的25.53%，差异有统计学意义（P<0.05）。结论：与PFNA内固定术相比，在高龄不稳定型股骨粗隆间骨折患者治疗中采用人工股骨头置换术具有疗效好、安全性高优势，但存在手术时间长，出血量多等不足，相对治疗价值较高。

【关键词】 股骨粗隆间骨折 PFNA内固定术 人工股骨头置换术 恢复效果 并发症

doi：10.14033/j.cnki.cfmr.2020.17.061 文献标识码 B 文章编号 1674-6805（2020）17-0-03

Effect of PFNA Internal Fixation and Artificial Femoral Head Replacement in Treatment of Elderly Patients with Unstable Intertrochanteric Fracture/XIE Baiyu. //Chinese and Foreign Medical Research， 2020， 18（17）： -145

[Abstract] Objective： To investigate the effect of PFNA internal fixation or artificial femoral head replacement in elderly patients with unstable intertrochanteric fracture. Method： A total of 78 patients with unstable femoral intertrochanteric fracture from April 2016 to April 2019 were selected， they were randomly divided into two groups， 39 cases in each group， artificial femoral head replacement was performed in the observation group， and PFNA internal fixation was performed in the control group， the operation index， recovery effect and complications of the two groups were compared. Result： The operative time in the observation group was longer than that in the control group， the intraoperative blood loss and postoperative drainage volume were more than those in the control group， the time of weight-bearing walking was earlier than that in the control group， the time of hospitalization and fracture healing were shorter than those in the control group， the differences were statistically significant （P<0.05）. The incidence of complications in the observation group was 8.51%， which was lower than 25.53% in the control group， the difference was statistically significant （P<0.05）. Conclusion： Compared with PFNA internal fixation， the use of artificial femoral head replacement in the treatment of elderly patients with unstable intertrochanteric fractures has good curative effect and high safety， but the operation time is long， the amount of bleeding is large， and the relative treatment value is high.

[Key words] Intertrochanteric fracture PFNA internal fixation Artificial femoral head replacement Recovery effect Complications

First-authors address： Gongan County Hospital of Chinese Medicine， Gongan 434300， China

股骨粗隆间骨折属于常见骨科疾病，在高龄群体发病率较高，与骨质疏松有明显关联。不稳定型股骨粗隆间骨折多受到间接外力引起，治疗方法较多，而传统保守治疗主要以胫骨结节及股骨髁上牵引为主，一般持续骨牵引时间6周，需较长卧床时间，易引发诸多并发症，如髋膝关节僵硬、泌尿系呼吸性感染、褥疮、靜脉血栓等，也易出现骨折畸形愈合，疗效不佳，多采用手术治疗[1]。人工股骨头置换术主要通过置换人工股骨头进行髋关节解剖重建，具有早期下地负重行走的优势而减少并发症，但存在出血量多、手术时间长等弊端。PFNA内固定术具有创伤小、出血量少等优势，但不能早期下地行走，术后并发症发生相对增多，恢复效果相对较差[2]。为此，本研究对高龄不稳定型股骨粗隆间骨折患者行PFNA内固定术或人工股骨头置换术治疗的效果进行了探讨，具体如下。……