余洋 谭彪 杨世鹏 孙瑗

摘 要：目的 評价PFNA与生物型人工股骨头置换术治疗老年不稳定型粗隆间骨折的临床疗效。方法 回顾性分析2012年1月～2015年12月采用不同术式治疗老年不稳定型粗隆间骨折患者35例，依据不同术式将35例患者分为两组，其中PFNA术28例，人工股骨头置换术7例。从手术时间、术中出血量、术后负重时间、术后Harris评分对两种术式进行比较。结果 随访12～24个月，PFNA28例，生物型人工股骨头置换术7例，两种术式在手术时间、术中出血量、术后引流量、下床活动时间上差异无统计学意义（P>0.05），但术后Harris评分PFNA术高于人工股骨头置换术，组间比较差异具有统计学意义（P<0.05）。结论 PFNA术与人工股骨头置换术治疗老年不稳定型粗隆间骨折临床疗效基本一致，但PFNA能使患者在早期随访中获得更高的Harris评分。

关键词：PFNA；生物型人工股骨头置换术；粗隆间骨折；不稳定

中图分类号：R687.3 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.06.027

文章编号：1006-1959（2018）06-0087-03

Clinical Observation of PFNA and Biological Artificial Femoral Head Replacement in the Treatment of Unstable Intertrochanteric Fractures in the Elderly

YU Yang1，TAN Biao2，YANG Shi-peng2，SUN Yuan3

（1.Department of Clinical Medicine，Chengdu University of Traditional Chinese Medicine/Department of Orthopaedics，Affiliated Hospital，Chengdu 610075，Sichuan，China；

2.Chengdu University of Chinese Medicine，Chengdu 610075，Sichuan，China；

3.Beijing University of Chinese Medicine，Beijing 100029，China）

Abstract：Objective To evaluate the clinical efficacy of PFNA and biological artificial femoral head replacement in the treatment of unstable intertrochanteric fractures in the elderly.Methods 35 patients with unstable intertrochanteric fractures were treated with different surgical methods from January 2012 to December 2015.According to different operation methods，35 patients were divided into two groups，including 28 cases of PFNA operation and 7 cases of artificial femoral head replacement.The two methods were compared from the operation time，the amount of bleeding in the operation，the time of post operation weight negative，and the Harris score after operation.Results The follow-up of 12～24 months，PFNA28 cases，7 cases of biological artificial femoral head replacement， two kinds of operation in the operation time，intraoperative bleeding volume，postoperative drainage，ambulation time had no significant difference（P>0.05），but the postoperative Harris score was higher than that of PFNA with artificial femoral head replacement，the differences between groups were statistically significant（P<0.05）.Conclusion The clinical efficacy of PFNA and artificial femoral head replacement in the treatment of unstable intertrochanteric fractures in elderly patients is basically the same，but PFNA can make the patients get a higher Harris score in early follow-up.

Key words：PFNA；Biological artificial femoral head replacement；Intertrochanteric fracture；Instability

股骨粗隆间骨折（intertrochanteric fracture of femur）是老年人群最常见的骨折之一，随着我国人口老龄化的发展其发生率在不断上升。老龄患者机体各项功能相对较弱，并常伴有多脏器功能损害和严重骨质疏松等，长期卧床容易引起肺部感染、泌尿系感染、褥疮等严重的并发症，危及生命[1，2]。为缩短卧床时间，减少并发症，老年股骨粗隆间骨折目前多以手术治疗为主[3]。由于人工假体材料的发展以及关节置换技术的日趋成熟，人工股骨头置换术也开始用于治疗高龄患者的股骨粗隆间骨折。本研究回顾性分析2012年1月～2015年12月采用PFNA与生物型人工股骨头置换术治疗老年不稳定型粗隆间骨折患者35例，并对其临床疗效进行评估。

1 资料与方法

1.1 一般资料 纳入标准：①我院2012年1月～2015年12月采用PFNA或生物型人工股骨头置换术治疗的粗隆间骨折病例；②……