高龄股骨粗隆间骨折内固定与半髋置换术后生存状况

Survival status of elderly patients with femoral intertrochanteric fractures treated by internal fixation versus hemiarthroplasty

摘要:

[目的] 回顾性比较股骨近端防旋髓内钉 （proximal femoral nail antirotation, PFNA） 与半髋置换 （hemiarthroplasty, HAP）治疗高龄股骨粗隆间骨折术后生存率和生存状态。[方法]回顾性分析 2018 年 1 月—2023 年 1 月本院手术治疗的 62 例高龄股骨粗隆间骨折。根据术前与家属沟通结果，27 例采用 PFNA，另外 35 例采用 HAP。比较患者围手术期相关数据，如手术时间、术中出血量及相关并发症等；随访患者 Harris 髋关节评分和日常生活活动能力 （activities of daily living, ADL） 评分， 以及患者生存情况，随访终点为术后 12 个月或死亡。[结果]PFNA 组在手术时间 [(51.9±5.2) min vs (69.3±4.8) min, P＜0.001]、手术中出血量 [(110.9±20.3) mL vs (191.7±10.6) mL, P＜0.001]、住院费用 [(1.3±0.6) 万元 vs (1.9±0.3) 万元, P 0.001] 显著优于 HAP 组， 但是前者在下地行走时间 [(6.2±0.9) d vs (4.8±0.6) d, P 0.001] 和住院时间 [(11.5±1.1) d vs (10.1±1.8) d, P 0.001] 显著不及后者。62 患者术后 1 年共死亡 17 例，总死亡率为 27.4%。术后 1 年 PFNA 组死亡 4 例，死亡率为 14.8%；HAP 组死亡 13 例，死亡率为 37.1%；两组间死亡率差异有统计学意义（P＜0.05）。排除死亡的 17 例，术后 1 个月，PFAN 组 Harris 评分和 ADL 评分均显著不及 HAP 组（P＜0.001）；术后 3 个月两组患者的 Harris 评分和 ADL 评分差异无统计学意义（P＞0.05）；末次随访时，PFNA 组的 Harris 评分和 ADL 评分显著优于 HAP 组（P＜0.05）。并发症方面，PFNA 组仅 1 例内固定松动；而 HAP 组切口愈合不良 4 例，假体脱位 3 例，假体周围骨折 1 例；两组间差异有统计学意义（P＜0.05）。[结论]本研究中，PFNA 在手术创伤、医疗费用、1 年生存状况均优于 HAP。提示 PFAN 仍应视为治疗高龄股骨粗隆间骨折的重要方法。

Abstract:

[Objective] To retrospectively compare the survival status of elderly patients with femoral intertrochanteric fractures treated by internal fixation of proximal femoral nail anti-rotation (PFNA) versus hemiarthroplasty (HAP). [Methods] A retrospective study was performed on 62 elderly patients who had femoral intertrochanteric fractures treated surgically in our hospital from January 2018 to January 2023. According to the preoperative communication with family members, 27 elderly received PFNA, while the other 35 cases received HAP. The perioperative data, such as operation time, intraoperative blood loss and related complications, were compared. Patients were evaluated with Harris hip score and activities of daily living (ADL) score, as well as survival condition until the end point of followup at 12 months after surgery or death. [Results] The PFAN cohort proved significantly superior to the HAP cohort in terms of operative time [(51.9± 5.2) min vs (69.3±4.8) min, P＜0.001], intraoperative blood loss [(110.9±20.3) mL vs (191.7±10.6) mL, P＜0.001], hospitalization cost [(1.3± 0.6) 10k yuan vs (1.9±0.3) 10k yuan, P＜0.001], although the former was significantly inferior to the latter in terms of walking time [(6.2±0.9) days vs (4.8±0.6) days, P＜0.001] and hospital stay [(11.5±1.1) days vs (10.1±1.8) days, P＜0.001]. A total of 17 patients died in a year after operation, with a total mortality of 27.4%. One year after operation, the PFNA group had 4 patients died with the mortality of 14.8%, whereas HAP group got 13 patients died accounting for 37.1%, and there was a significant difference in mortality between the two groups (P＜0.05). Excluding the 17 cases of death, the Harris score and ADL score in the PFAN group were significantly lower than those in HAP group one month after operation (P＜0.001), whereas which became not significantly different between them 3 months after surgery (P＞0.05). However, the Harris score and ADL score in the PFNA group were significantly better than those in the HAP group at the latest follow-up (P＜0.05). In terms of complications, there was only 1 case of loosening of internal fixation in the PFNA group, by contrast, there were 4 cases of poor incision healing, 3 cases of prosthesis dislocation and 1 case of periprosthetic fracture in the HAP group, and the difference between the two groups was statistically significant (P<0.05). [Conclusion] In this group of patients, PFNA is superior to HAP regarding surgical trauma, medical cost and survival status in a year postoperatively. It is suggested that PFAN should still be considered as an important method for the treatment of femoral intertrochanteric fractures in the elderly.