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无水泥型股骨距置换半髋关节成形术与股骨近端髓内钉治疗老年不稳定型股骨转子间骨折的比较

Comparison of Cementless Calcar-Replacement Hemiarthroplasty With Proximal Femoral Nail for the Treatment of Unstable Intertrochanteric Fractures at Older Age Group.

作者信息

Agar Anıl, Sahin Adem, Gunes Orhan, Gulabi Deniz, Erturk Cemil

机构信息

Orthopaedics and Traumatology Department, Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, TUR.

出版信息

Cureus. 2021 Jan 22;13(1):e12854. doi: 10.7759/cureus.12854.

Abstract

BACKGROUND

The aim of this study was to compare the outcomes of unstable intertrochanteric femur fractures treated with cementless calcar-replacement bipolar hemiarthroplasty (CRH) and proximal femoral nail (PFN) in elderly patients.

METHODS

All consecutive unstable intertrochanteric fractures treated with cementless CRH or PFN at our institution between January 2015 and January 2019 were reviewed retrospectively. The primary outcome measures were postoperative complications, reoperation rate, and hip function. The secondary outcome measures were intraoperative blood loss, transfusion rate, surgical time, hospital stay, and two- year mortality.

RESULTS

Ninety-four patients in the hemiarthroplasty group and 77 patients in the PFN group were included for analysis. There were no significant differences between the two groups regarding the complications, ASA score, and reoperation rate. Significant differences were found between hemiarthroplasty and PFN group in comparison of the average length of hospital stay (P < 0.05), time from hospitalization to operation (P < 0.05), intraoperative blood loss (P < 0.001), transfusion rate (P < 0.001), operation time (P < 0.001), Harris Hip Score (HHS; P < 0.001), and two-year mortality (P < 0.05).

CONCLUSION

Both hemiarthroplasty and PFN produce satisfactory results in surgically treated unstable intertrochanteric femur fractures in the elderly. Both groups are associated with their own complications, but in the PFN group, better functional results, less surgery-related trauma, and lower mortality rates are the main advantages.

摘要

背景

本研究旨在比较老年患者不稳定型股骨粗隆间骨折采用无骨水泥股骨距替代双极半髋关节置换术(CRH)和股骨近端髓内钉(PFN)治疗的效果。

方法

回顾性分析2015年1月至2019年1月在我院采用无骨水泥CRH或PFN治疗的所有连续性不稳定型股骨粗隆间骨折患者。主要观察指标为术后并发症、再次手术率和髋关节功能。次要观察指标为术中失血量、输血率、手术时间、住院时间和两年死亡率。

结果

半髋关节置换组94例患者和PFN组77例患者纳入分析。两组在并发症、美国麻醉医师协会(ASA)评分和再次手术率方面无显著差异。半髋关节置换组和PFN组在平均住院时间(P<0.05)、住院至手术时间(P<0.05)、术中失血量(P<0.001)、输血率(P<0.001)、手术时间(P<0.001)、Harris髋关节评分(HHS;P<0.001)和两年死亡率(P<0.05)方面存在显著差异。

结论

半髋关节置换术和PFN治疗老年不稳定型股骨粗隆间骨折手术均取得满意效果。两组均有各自的并发症,但PFN组功能结果更好、手术相关创伤更小且死亡率更低是主要优势。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b915/7897399/d0583ad649bf/cureus-0013-00000012854-i03.jpg

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