股骨头置换与髓内钉固定老年股骨粗隆间骨折比较△（开放获取）

(Open Access) Hip hemiarthroplasty versus intramedullary nail fixation for femoral intertrochanteric fractures in elderly

摘要:

[目的] 比较股骨头置换与髓内钉固定治疗老年股骨粗隆间骨折的临床疗效。[方法] 回顾性分析本院2015 年8 月—2020 年8 月128 例老年股骨粗隆间骨折患者的临床资料，根据医患沟通结果，66 例采用股骨头置换（置换组），62 例采用髓内钉固定（固定组），比较两组围手术期、随访及影像结果。[结果] 置换组的手术时间[(62.9±5.2) min vs (52.5±4.9) min, P＜0.001]、切口总长度[(15.1±0.8) cm vs (12.2±0.8) cm, P＜0.001]、术中失血量[(301.8±40.9) ml vs (142.9±20.2) ml, P＜0.001]、住院时间[(13.7±1.1) d vs (12.6±1.5) d, P＜0.001] 均显著多于固定组，但术中透视次数[(3.5±1.1) 次vs (13.8±2.1) 次, P＜0.001] 和下地行走时间[(3.4±1.3) d vs (18.0±4.6) d, P＜0.001] 显著少于固定组。置换组的完全负重时间[(24.0±2.0) d vs (59.4±2.6) d, P＜0.001] 显著早于固定组。随时间推移，两组VAS 评分、Harris 评分均显著改善（P＜0.05），术后相应时间点置换组VAS 评分显著优于固定组（P＜0.05）；置换组术后1、3 个月的Harris 评分显著优于固定组（P＜0.05）。影像方面，与术前相比，末次随访时，置换组双侧肢长差显著减小；与术后即刻相比，末次随访时固定组颈干角（femoral neck shaft angle, FNSA） 显著减小（P＜0.05），顶尖距（tip-apex distance, TAD） 显著增加（P＜0.05）。[结论] 对于老年股骨粗隆间骨折，髓内钉内固定和股骨头置换均可取得较好疗效，相比较而言，只要术前患者本身条件许可，股骨头置换更具有优势。

Abstract:

[Objective] To compare the clinical outcomes of hip hemiarthroplasty versus internal fixation with proximal femoral nail an-ti-rotation (PFNA) for femoral intertrochanteric fractures in the elderly. [Methods] A retrospective study was conducted on 128 elderly pa-tients who received surgical treatment for femoral intertrochanteric fractures in our hospital from August 2015 to August 2020. According tothe preoperative doctor-patient communication, 66 patients received hip hemiarthroplasty (the hemiarthroplasty group), while other 62 pa-tients received PFNA fixation (the PFNA group). The documents regarding to perioperative period, follow-up and images were compared be-tween the two groups. [Results] Although the hemiarthroplasty group proved significantly greater than the PFNA group in terms of operativetime [(62.9±5.2) min vs (52.5±4.9) min, P＜0.001], total incision length [(15.1±0.8) cm vs (12.2±0.8) cm, P＜0.001], intraoperative blood loss[(301.8±40.9) ml vs (142.9±20.2) ml, P＜0.001], and length of hospital stay [(13.7±1.1) days vs (12.6±1.5) days, P＜0.001], the former wassignificantly better than the latter in intraoperative fluoroscopy times [(3.5±1.1) times vs (13.8±2.1) times, P＜0.001] and the ambulationtime [(3.4±1.3) days vs (18.0±4.6) days, P＜0.001]. In addition, the hemiarthroplasty group regained full weight bearing activity significantlyearlier than the PFNA group [(24.0±2.0) days vs (59.4±2.6) days, P＜0.001]. The VAS score and Harris score significantly improved in bothgroups over time (P＜0.05), and the hemiarthroplasty group was significantly superior to the PFNA group in terms of VAS score at all timepoint after surgery (P＜0.05), and Harris scores at 1 and 3 months after operation (P＜0.05). With respect of imaging, the leg length discrep-ancy in the hemiarthroplasty group significantly reduced at the last follow-up compared with that before surgery. On other hand, the femoralneck shaft angle (FNSA) significantly decreased (P＜0.05), whereas the tip-apex distance (TAD) significantly increased in the PFNA groupat the last follow-up compared with those immediately after operation (P＜0.05). [Conclusion] Both hemiarthroplasty and PFNA fixationachieve satisfactory consequences for femoral intertrochanteric fractures in the elderly. In comparison, hemiarthroplasty is more advanta-geous as long as the patient's own conditions permit before surgery.