Esen Erdinç, Dur Hakan, Ataoğlu M Baybars, Ayanoğlu Tacettin, Turanlı Sacit
Department of Orthopedics and Traumatology, Medical Faculty of Gazi University, 06500 Beşevler, Ankara, Turkey.
Eklem Hastalik Cerrahisi. 2017 Apr;28(1):35-40. doi: 10.5606/ehc.2017.53247.
This study aims to assess the mortality and morbidity rates of patients with intertrochanteric femoral fractures who were performed proximal femoral nail-antirotation (PFNA) or cemented, bipolar hemiarthroplasty with calcar replacement.
A total of 127 patients (42 males, 85 females; mean age 79.2 years; range 55 to 98 years) who were treated due to proximal femoral fracture between January 2008 and January 2011 were compared retrospectively in terms of intraoperative mortality, total mortality, and monthly distribution of mortality rates. Of these 127 patients, 92 (28 males, 64 females; mean age 80.24 years; range 55 to 94 years) who were alive, who achieved at least a 12-month follow-up, and could walk and fulfil daily activities in preoperative period were included in the study. Patients were divided into two groups as PFNA group (n=34) and cemented, bipolar hemiarthroplasty with calcar replacement group (hemiarthroplasty group; n=58). Both groups were compared in terms of duration of operation, requirement for intraoperative blood transfusion, duration of hospital stay, functional outcomes, quality of life, complication and revision rates, and costs of operation.
Patients in both groups had the same type of fracture. Bone mineral densitometry results and the type and risk of anesthesia of both groups were similar. No significant difference was detected between two groups in terms of intraoperative mortality, total mortality, and monthly distribution of mortality rates (p>0.05). Mean durations of operation were 54.85 minutes (range 40-110 minutes) and 74.66 minutes (range 55-120 minutes) in the PFNA and hemiarthroplasty groups, respectively. Mean durations of hospital stay were 5.91 days (range 5-12 days) and 9.41 days (range 6-16 days) in the PFNA and hemiarthroplasty groups, respectively. In the PFNA group, durations of operation and hospital stay were shorter and functional results were superior (p<0.05). Requirement for blood transfusion was lower in the PFNA group.
Both PFNA and cemented, bipolar hemiarthroplasty with calcar replacement are good techniques in treatment of intertrochanteric femoral fractures. Internal fixation may be more appropriate for elderly patients due to shorter duration of operation and lower risk of reoperation.
本研究旨在评估接受股骨近端防旋髓内钉（PFNA）或带距置换的骨水泥型双极半髋关节置换术治疗的股骨转子间骨折患者的死亡率和发病率。
回顾性比较2008年1月至2011年1月期间因股骨近端骨折接受治疗的127例患者（42例男性，85例女性；平均年龄79.2岁；范围55至98岁）的术中死亡率、总死亡率及死亡率的月度分布。这127例患者中，92例（28例男性，64例女性；平均年龄80.24岁；范围55至94岁）存活，至少有12个月的随访，且术前能够行走并完成日常活动，纳入本研究。患者分为两组，即PFNA组（n = 34）和带距置换的骨水泥型双极半髋关节置换术组（半髋关节置换术组；n = 58）。比较两组的手术时长、术中输血需求、住院时长、功能结局、生活质量、并发症及翻修率以及手术费用。
两组患者骨折类型相同。两组的骨密度测量结果以及麻醉类型和风险相似。两组在术中死亡率、总死亡率及死亡率的月度分布方面未检测到显著差异（p>0.05）。PFNA组和半髋关节置换术组的平均手术时长分别为54.85分钟（范围40 - 110分钟）和74.66分钟（范围55 - 120分钟）。PFNA组和半髋关节置换术组的平均住院时长分别为5.91天（范围5 - 12天）和9.41天（范围6 - 16天）。PFNA组的手术时长和住院时长较短，功能结果更佳（p<0.05）。PFNA组的输血需求较低。
PFNA和带距置换的骨水泥型双极半髋关节置换术都是治疗股骨转子间骨折的良好技术。由于手术时长较短且再次手术风险较低，内固定可能更适合老年患者。
