目的：探讨人工全髋关节置换术（total hip arthroplasty，THA）与股骨近端钉（proximal femoral nail antirotation，PFNA）在老年股骨转子间骨折的临床疗效。方法：选取本院2009年2月-2012年2月收治住院的股骨转子间骨折老年患者200例，随机分为THA组100例与PFNA组100例。THA组采用人工全髋关节置换术治疗；PFNA组采用股骨近端钉内固定术治疗。观察并对比两组患者的临床指标如手术时间、术中出血量、术中X线透视次数、下床活动时间、并发症、住院天数等，采用MedliD’Aubigne评分方法评价髋关节功能。结果：两组患者的手术时间比较差异无统计学意义（P>0.05）；THA组术中出血量较PFN组多，差异具有统计学意义（P<0.05）；THA组患者术中X线透视次数、平均术后下床活动时间、平均住院时间、并发症发生率均较PFNA组低，差异具有统计学意义（P<0.05）；THA组髋关节功能优良率比PFNA组高，差异具有统计学意义（P<0.05）。结论：人工全髋关节置换是治疗高龄患者股骨转子间骨折的重要方法，具有良好的临床疗效。%Objective:To discuss the clinical effect of the intertrochanteric fracture treated by artificial total hip arthroplasty(THA)and proximal femoral nail antirotation(PFNA).Method:200 cases of intertrochanteric fracture in elderly patients from February 2009-February 2012 to our hospital were selected,who were randomly divided into experimental group(THA group)and control group(PFNA group),100 cases in each group.THA group were treated with artificial total hip arthroplasty;PFNA group were treated with proximal femoral antirotation nail fixation.Observed and compared the clinical indicators such as operation time,intraoperative blood loss,intraoperative X-ray fluoroscopy times,ambulation time,complications, hospitalization days,etc of the two groups,and evaluate hip joint function by MedliD ’Aubigne grading.Result:The operation time of the two groups of patients had no significant difference(P>0.05);THA loss more blood intraoperatie compared with PFN group,with significant difference(P<0.05);THA group,s intraoperative X-ray perspective,the average number of leave bed activity time,average hospital stay,postoperative complication rates were relatively lower than those of the PFNA group,with significant difference(P<0.05);THA group,s hip function was better than that of the PFNA group,with significant difference(P<0.05).Conclusion:Artificial total hip arthroplasty are important in the treatment of elderly patient’s femoral intertrochanteric fracture,which has good clinical curative effect.
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