大粗隆式股骨柄与股骨近端防旋髓内钉治疗高龄不稳定粗隆间骨折的临床观察

doi:10.3969/j.issn.1005-6483.2019.11.018

摘要/Abstract

摘要： 目的：分析大粗隆式股骨柄（GTF）与股骨近端防旋髓内钉（PFNA）治疗高龄不稳定粗隆间骨折的临床疗效。方法：2012年1月～2018年3月高龄不稳定粗隆间骨折病人88例，根据手术方式不同分为两组，GTF组45例，采用大粗隆式股骨柄髋关节置换治疗；PFNA组43例，采用股骨近端防旋髓内钉治疗。比较两组病人切口长度、手术时间、术中失血量、术后引流量、负重时间以及末次随访髋关节Harris评分等。结果：88例病人均得到随访，时间1.2～6年，平均3.3年。GTF组负重下床活动时间较PFNA组短，手术切口长度较PFNA组长，术中出血量、术后引流量较PFNA组多，差异有统计学意义（P<0.05）。两组手术时间比较差异无统计学意义（P>0.05）。GTF组末次随访髋关节Harris评分高于PFNA组，两组比较差异有统计学意义（P<0.05）。结论：GTF与PFNA均为治疗高龄不稳定粗隆间骨折的有效治疗术式，GTF可早期下床活动，减少术后并发症，配合术后早期功能锻炼能尽快恢复髋关节功能，对高龄不稳定粗隆间骨折尤为适宜。

关键词: 股骨粗隆间骨折, 大粗隆式股骨柄, 股骨近端防旋髓内钉

Abstract: Objective：To evaluate the clinical effects of greater trochanter femoral stem （GTF）and proximal femoral nail antirotation （PFNA）for the treatment of unstable intertrochanteric fractures in the elderly.Methods：A review study was conducted on 88 unstable intertrochanteric fractures in the elderly treated with GTF and PFNA form January 2012 to March 2018.The patients were divided into GTF（n=45）and PFNA（n=43）.The incision length，operation time，intraoperative blood loss，postoperative blood loss，weightbearing time，and Harris score of the last followup were compared between the two groups.Results： All 88 patients were followed up for 1.2 to 6 years with an averaged of 3.3 years.Compared with PFNA group，GTF group had shorter time to get out of bed with load，longer incision length，more bleeding volume during operation and more drainage volume after operation，the difference was statistically significant（P<0.05）.There was no significant difference in operation time between the two groups（P>0.05）.In the last followup，Harris score of hip joint in GTF group was significantly higher than that in PFNA group（P>0.05）.The difference between the two groups was statistically significant（P<0.05）.Conclusion：Both GTF and PFNA are effective methods for the treatment of unstable intertrochanteric fracture in the elderly.GTF can get out of bed early and reduce complications after operation.It can restore hip function as soon as possible with early functional exercise after operation which is especially suitable for unstable intertrochanteric fracture in the elderly.

Key words: intertrochanteric fracture, greater trochanter femoral stem, proximal femoral nail antirotation

陈金, 王光勇, 肖宁等. 大粗隆式股骨柄与股骨近端防旋髓内钉治疗高龄不稳定粗隆间骨折的临床观察[J]. 临床外科杂志, 2019, 27(11): 981-983.

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