PFNA內(nèi)固定術(shù)治療老年股骨粗隆間骨折對(duì)術(shù)后關(guān)節(jié)功能恢復(fù)的影響

【摘要】 目的：觀察股骨近端防旋髓內(nèi)釘（PFNA）內(nèi)固定術(shù)對(duì)老年股骨粗隆間骨折患者關(guān)節(jié)功能恢復(fù)的影響。方法：選取2018年1月—2022年1月九江市第一人民醫(yī)院收治的老年股骨粗隆間骨折患者共68例，以隨機(jī)數(shù)字表法分為觀察組（34例）與對(duì)照組（34例），對(duì)照組實(shí)施半髖關(guān)節(jié)置換術(shù)治療，觀察組實(shí)施PFNA內(nèi)固定術(shù)治療。觀察兩組治療效果、手術(shù)指標(biāo)、疼痛程度、髖關(guān)節(jié)功能（Harris評(píng)分）及骨密度水平。結(jié)果：觀察組總優(yōu)良率為97.06%，優(yōu)于對(duì)照組的82.36%，差異有統(tǒng)計(jì)學(xué)意義（Plt;0.05）；與對(duì)照組比較，觀察組術(shù)中出血量、術(shù)后引流量均更少，手術(shù)時(shí)間、住院時(shí)間均更短（Plt;0.05）。術(shù)后8、24、48 h，觀察組視覺(jué)模擬評(píng)分法（visual analogue scale，VAS）評(píng)分均低于對(duì)照組（Plt;0.05）。術(shù)前，兩組Harris評(píng)分、骨密度（股骨大粗隆、股骨頸及Ward三角區(qū)）水平比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（Pgt;0.05）；術(shù)后3個(gè)月及6個(gè)月，觀察組Harris評(píng)分均高于術(shù)前與對(duì)照組（Plt;0.05）。術(shù)后6個(gè)月，兩組股骨大粗隆、Ward三角區(qū)、股骨頸骨密度水平均高于術(shù)前，且觀察組均高于對(duì)照組（Plt;0.05）。結(jié)論：PFNA內(nèi)固定術(shù)可縮短老年股骨粗隆間骨折患者手術(shù)治療時(shí)間，對(duì)術(shù)中出血量及術(shù)后引流量均可明顯減少，減輕術(shù)后疼痛程度，并縮短住院時(shí)間，改善髖關(guān)節(jié)功能，并糾正骨量流失與骨質(zhì)疏松狀況，臨床療效顯著，可作為臨床治療老年股骨粗隆間骨折的優(yōu)選方案。

【關(guān)鍵詞】 老年 股骨粗隆間骨折 PFNA內(nèi)固定術(shù) 關(guān)節(jié)功能 骨密度

Effect of PFNA Internal Fixation on the Recovery of Postoperative Joint Function in the Treatment of Elderly Patients with Intertrochanteric Fracture of Femur/YANG Minjie， YANG Yonghua， HU Bin， LUO Sumei. //Medical Innovation of China， 2023， 20（31）： 0-050

[Abstract] Objective： To observe the effect of proximal femoral nail anti rotation （PFNA） internal fixation on the recovery of joint function in elderly patients with intertrochanteric fracture of femur. Method： A total of 68 elderly patients with intertrochanteric fracture of femur in Jiujiang NO.1 People's Hospital from January 2018 to January 2022 were selected and divided into observation group （34 cases） and control group （34 cases） by random number table method. The control group was treated with hemiarthroplasty， while the observation group was treated with PFNA internal fixation. The therapeutic effect， surgical indexes， pain degree， hip function （Harris score） and bone mineral density of the two groups were observed. Result： The total excellent and good rate in the observation group was 97.06%， which was better than 82.36% in the control group， the difference was not statistically significant （Plt;0.05）. Compared with the control group， the intraoperative bleeding volume and postoperative drainage volume in the observation group were less， and the operation time and hospitalization time were shorter （Plt;0.05）. At 8， 24， 48 h after operation， the visual analogue scale （VAS） scores in the observation group were lower than those in the control group （Plt;0.05）. There were no significant differences in Harris score and bone mineral density （greater trochanter， femoral neck and Ward triangle） between the two groups before operation （Pgt;0.05）. At 3 and 6 months after operation， Harris scores of the observation group were lower than those of preoperative and control group （Plt;0.05）. Six months after operation， the bone mineral density levels of femoral trochanter， Ward triangle and femoral neck in both groups were higher than those before operation， and the observation group were higher than those in the control group （Plt;0.05）. Conclusion： PFNA internal fixation can shorten the operation time in elderly patients with intertrochanteric fracture of femur， reduce the amount of intraoperative bleeding and postoperative drainage volume， reduce the degree of postoperative pain， shorten the hospital stay， improve hip joint function， and correct the bone loss and osteoporosis， has a significant effect in the treatment of elderly intertrochanteric fracture of femur， it can be used as the optimal scheme for clinical treatment of elderly intertrochanteric fracture of femur.

[Key words] Elderly Intertrochanteric fracture of femur PFNA internal fixation Joint function Bone mineral density

First-author's address： Jiujiang NO.1 People's Hospial， Jiangxi Province， Jiujiang 332000， China

doi：10.3969/j.issn.1674-4985.2023.31.011

股骨粗隆間骨折在髖部骨折類型中較為常見(jiàn)，是發(fā)生在股骨頸基底至小粗隆之間的骨折，以老年群體為高發(fā)人群，這與老年群體骨質(zhì)量與骨密度降低有關(guān)[1]。……