骨水泥型半髋关节置换术与股骨近端防旋髓内钉治疗老年股骨转子间骨折：一项病例对照研究。

Cemented hemiarthroplasty versus proximal femoral nail antirotation in the management of intertrochanteric femoral fractures in the elderly: a case control study.

机构信息

China Medical University, Shenyang, Liaoning, China.

Department of Emergence Medicine, Shengjing Hospital Affiliated China Medical University, Shenyang, Liaoning, China.

出版信息

BMC Musculoskelet Disord. 2021 Oct 5;22(1):846. doi: 10.1186/s12891-021-04586-x.

BACKGROUND

The treatment for intertrochanteric femoral fractures (IFF) among the elderly has been a controversial topic. Hemiarthroplasty (HA) and proximal femoral nail antirotation (PFNA) have their own advantages in the management of IFF. Hence, this study aims to compare and analyze differences in the effectiveness of both procedures on IFF among the elderly.

METHODS

Overall, 99 patients (81.09 ± 8.29 years; 68 women) underwent HA or PFNA from January 2016 to May 2020. IFF were classified according to the Arbeitsgemeins für Osteosynthesefragen (AO) classification. The difference in underlying diseases, the American Society of Anesthesiologists (ASA) grade, Singh index, Harris scores, surgical time, intraoperative bleeding, postoperative blood test results, postoperative number of days to partially bearing weight, and survival outcomes were analyzed. Postoperative follow-ups were performed every 3 months.

RESULTS

There was no significant difference in the AO classification, underlying diseases, ASA grade, Singh index, surgical time, and survival outcomes of the HA (45 patients) group and PFNA group (54 patients). The HA group was associated with earlier partial weight-bearing (HA: 4 [2 ~ 4.5] days, PFNA: 10 [8~14] days). It also had a higher total Harris score than the PFNA group at the 6-month follow-up visit (HA: 86.8 [81.90 ~ 90.23], PFNA: 83.48 [75.13 ~ 88.23]). Harris scores decreased more in patients aged ≥90 years in the PFNA group than in the HA group. The postoperative stress recovery rate in the HA group was faster based on postoperative blood test results.

CONCLUSIONS

PFNA and HA have good therapeutic effects in the treatment of IFF. The advantages of HA were reflected in short-term weight bearing, faster recovery from stress, and better joint function in the long term. This advantage is more obvious in the patient population aged over 90 years. Therefore, we suggest that surgeons should consider the benefit of HA in the treatment of IFF among the elderly.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR2000035814. Registered 17 August 2020, https://www.chictr.org.cn/showproj.aspx?proj=57083.

背景

老年人股骨转子间骨折（IFF）的治疗一直是一个有争议的话题。半髋关节置换术（HA）和股骨近端防旋髓内钉（PFNA）在治疗 IFF 方面各有优势。因此，本研究旨在比较和分析这两种手术治疗老年人 IFF 的效果差异。

方法

2016 年 1 月至 2020 年 5 月，共有 99 例患者（81.09±8.29 岁；68 例女性）接受 HA 或 PFNA 治疗。IFF 根据 Arbeitsgemeins für Osteosynthesefragen（AO）分类进行分类。分析了基础疾病、美国麻醉师协会（ASA）分级、Singh 指数、Harris 评分、手术时间、术中出血量、术后血液检查结果、术后部分负重天数以及生存结果的差异。术后每 3 个月进行随访。

结果

HA（45 例）组和 PFNA 组（54 例）的 AO 分类、基础疾病、ASA 分级、Singh 指数、手术时间和生存结果无显著差异。HA 组开始部分负重的时间更早（HA：4[2~~4.5]天，PFNA：10[8~~14]天）。在 6 个月的随访中，HA 组的总 Harris 评分也高于 PFNA 组（HA：86.8[81.90~~90.23]，PFNA：83.48[75.13~~88.23]）。PFNA 组≥90 岁的患者术后 Harris 评分下降更为明显。基于术后血液检查结果，HA 组的应激恢复速度较快。