股骨近端防旋髓内钉与非骨水泥双极人工股骨头置换治疗老年不稳定股骨转子间骨折：一项回顾性研究。
Proximal femoral nail anti-rotation versus cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture in the elderly: a retrospective study.
机构信息
Department of Joint Surgery, Institute of Orthopedics, Xijing Hospital of Fourth Military Medical University, Xi'an, 710032, China.
Department of Joint Surgery, Institute of Orthopedics, General Hospital of Lanzhou Military Command, Lanzhou, 730050, China.
出版信息
BMC Musculoskelet Disord. 2019 Oct 29;20(1):500. doi: 10.1186/s12891-019-2793-8.
BACKGROUND
The treatment for unstable intertrochanteric fractures in the elderly has always been a controversial issue. The aim in this study was to compare the curative effects of proximal femoral nail anti-rotation (PFNA) and cementless bipolar hemiarthroplasty (CPH) on femoral intertrochanteric fracture in the elderly.
METHODS
From March 2008 to December 2012, 108 elderly patients with femoral intertrochanteric fractures were treated by PFNA or CPH. There were 63 males and 45 females, aged 75.3-99.1 years [(83.7 ± 5.6) years]. The patients' bone mineral density was routinely measured, and the fractures were classified according to Evans-Jensen. The patients were divided into CPH group and PFNA group. The differences in operation time, intraoperative bleeding, immobilization duration, hospitalization time, Harris scores and postoperative complications including deep venous thrombosis, lung and urinary infection were analyzed.
RESULTS
All patients were followed for 12.5-36.2 months [(28.0 ± 6.3) months)]. The operation time was (53.7 ± 15.2) min and (77.5 ± 16.8) min in PFNA group and CPH group, respectively (P < 0.05); intraoperative bleeding was (132.5 ± 33.2) mL and (286.3 ± 43.2) mL, respectively (P < 0.05); immobilization duration was (28.2 ± 3.7) days and (3.1 ± 1.2) days, respectively (P < 0.05); hospitalization time was (7.6 ± 1.8) days and (6.9 ± 2.2) days, respectively (P > 0.05); and the Harris scores after 1 year were (87.7 ± 7.9) points and (88.3 ± 9.2) points, respectively (P > 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05).
CONCLUSION
Both PFNA and CPH are safe and effective treatments for femoral intertrochanteric fracture in elderly patients. Nonetheless, CPH allows faster mobilization and recovery.
TRIAL REGISTRATION
Registration Number: ChiCTR1900022846 . Reg Date:2019-04-26 00:27:33 Retrospective registration.
背景
老年人不稳定型股骨转子间骨折的治疗一直是一个有争议的问题。本研究旨在比较股骨近端防旋髓内钉（PFNA）和非骨水泥双极人工股骨头置换术（CPH）治疗老年人股骨转子间骨折的疗效。
方法
2008 年 3 月至 2012 年 12 月，采用 PFNA 或 CPH 治疗 108 例老年股骨转子间骨折患者。男 63 例，女 45 例；年龄 75.3-99.1 岁，平均 83.7±5.6 岁。常规测量患者的骨密度，根据 Evans-Jensen 进行骨折分类。将患者分为 CPH 组和 PFNA 组。分析两组患者的手术时间、术中出血量、固定时间、住院时间、Harris 评分及术后深静脉血栓、肺部感染和尿路感染等并发症的差异。
结果
所有患者均获得 12.5-36.2 个月（28.0±6.3 个月）随访。PFNA 组和 CPH 组手术时间分别为（53.7±15.2）min 和（77.5±16.8）min（P<0.05）；术中出血量分别为（132.5±33.2）ml 和（286.3±43.2）ml（P<0.05）；固定时间分别为（28.2±3.7）d 和（3.1±1.2）d（P<0.05）；住院时间分别为（7.6±1.8）d 和（6.9±2.2）d（P>0.05）；术后 1 年 Harris 评分分别为（87.7±7.9）分和（88.3±9.2）分（P>0.05）。两组术后并发症发生率差异无统计学意义（P>0.05）。
结论
PFNA 和 CPH 均为治疗老年股骨转子间骨折安全有效的方法，但 CPH 可更快地促进患者康复。
试验注册
注册号：ChiCTR1900022846；注册日期：2019-04-26 00:27:33；回顾性注册。
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