摘要
目的探讨防旋股骨近端髓内钉(PFNA)治疗老年股骨粗隆间骨折的疗效及安全性分析。方法前瞻性收集2017年1月至2019年1月在张家口市第二医院行X线检查确诊的老年股骨粗隆间骨折患者82例。采用随机数法将其分为对照组和观察组,各41例。对照组采用经皮加压钢板(PCCP)治疗,观察组采用PFNA治疗。比较两组临床疗效、手术情况和术后住院时间,术前、术后1 w、半年及1年的髋关节功能(Harris)评分;统计两组治疗期间的满意率、随访结果及并发症发生率。结果两组患者随访时间为1年12~18个月,随访率100%。术后1 w观察组优良率为90.24%,对照组为87.80%,两组优良率比较,差异无统计学意义(P>0.05);观察组手术切口为(11.2±3.1)cm,长于对照组的[(6.5±1.7)cm,t=8.598,P<0.05],术中出血量为(157±32)ml,多于对照组的[(39±12)ml,t=22.230,P<0.05],术后住院时间为(12±4)d,短于对照组的[(16±5)d,t=3.595,P<0.05];两组手术时间比较,差异无统计学意义(P>0.05);观察组术后1 w的Harris评分为(42±6)分,高于对照组的[(40±5)分,F=4.056,P<0.05];术后半年的Harris评分为(82±5)分,高于对照组的[(78±5)分,F=8.191,P<0.05];术后1年两组Harris评分比较,差异无统计学意义(P>0.05);观察组满意率为85.37%,对照组为90.24%,两组满意率比较,差异无统计学意义(P>0.05)。观察组术后并发症发生率为7.32%,对照组为19.51%,两组并发症发生率比较,差异具有统计学意义(χ^2=7.458,P<0.05)。术后1年,观察组复发率为4.88%,对照组为12.20%,两组复发率比较,差异具有统计学意义(χ^2=2.145,P<0.05)。结论采用PFNA和PCCP治疗老年股骨粗隆间骨折均取得较好的临床效果,且采用PFNA治疗的患者术后住院时间明显缩短,髋关节功能恢复较好。
Objective To investigate the efficacy and safety of proximal femoral nail anti-rotation(PFNA)in the treatment of old intertrochanteric fractures.Methods A total of 82 patients with old intertrochanteric fractures confirmed by X-ray examination in our hospital between January 2017 and January 2019 were selected.They were divided into the control group and the observation group by random number method,each groups were 41 cases.The control group was treated with percutaneous compression plating(PCCP),and the observation group was treated with PFNA.The clinical efficacy,surgical status and postoperative hospital stay,preoperative,the score of Harris at postoperative 1 week,6 months and 1 year postoperative were compared;the satisfaction rate,follow-up results and complications during the treatment period rate were counted.Results The excellent and good rate in the observation group was 90.24%,and the excellent and good rate in the control group was 87.80%,there was no obvious difference in the excellent rate between the two groups(P>0.05).The surgical incision in the observation group was(11.2±3.1)cm,which was longer than[(6.5±1.7)cm,P<0.05]in the control group.The intraoperative blood loss was(157±32)ml,which was more than the[(39±12)ml,P<0.05].The postoperative hospital stay was(12±4)d,which was shorter than that in the control group[(16±5)d,P<0.05].There was no significant difference in surgical time between the two groups(P>0.05);the score of Harris in the observation group at 1 week after surgery was(42±6)points,which was higher than the control group’s[(40±5)points,P<0.05];the score of Harris in the observation group at the first half in the postoperative period was(82±5)points,higher than the control group[(78±5)points,P<0.05];there was no significant difference in the score of Harris between the two groups at one year after operation(P>0.05);the satisfaction rate in the observation group was 85.37%,the control group was 90.24%there was no significant difference in the satisfaction rate between the two groups(P>0.05).The incidence of postoperative complications in the observation group was 7.32%,and that in the control group was 19.51%.There was a statistically significant difference in the incidence of complications between the two groups(P<0.05).One year after surgery,the recurrence rate in the observation group was4.88%and that in the control group was 12.20%.The difference between the two groups was statistically significant(P<0.05).Conclusion Using PFNA and PCCP treat the old intertrochanteric fractures has achieved good clinical results,and with PFNA treatment,the postoperative hospital stay was significantly shortened,and hip function recovery was better.
作者
陈光伟
Chen guangwei(Department of Trauma,Zhangjiakou2st hospital,zhangjiakou 075000,China)
出处
《中华老年骨科与康复电子杂志》
2020年第3期142-147,共6页
Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)
基金
河北省重点研发项目(20191835)。
