目的 比较人工股骨头置换与股骨近端防旋髓内针(PFNA-Ⅱ)治疗高龄患者不稳定股骨粗隆间骨折(IFF)的临床疗效.方法 高龄不稳定型股骨粗隆间骨折患者90例,随机分为人工股骨头置换术组(置换组)及 PFNA-Ⅱ内固定手术组(内固定组).比较两组手术情况(手术时间、围手术期出血量)、术后Harris评分、住院天数、首次下地时间、完全负重时间及并发症发生情况.结果 置换组手术时间和围手术期出血量明显多于内固定组(P0.05);置换组住院天数、首次下地时间及完全负重时间明显短于内固定组(P0.05).结论 两种手术方式对高龄不稳定型IFF患者均有良好疗效,PFNA-Ⅱ内固定手术适用于大部分老年不稳定型IFF,而人工股骨头置换则适用于合并严重骨质疏松或对早期功能康复锻炼有特殊要求的患者.%Objective To compare the clinical efficacy of artificial femoral head replacement and proximal femoral nail antirotation-II(PFNA-II)in the treatment of unstable intertrochanteric femoral fractures(IFF)in elderly patients. Methods 90 elderly patients with unstable intertrochanteric fractures were randomly divided into artificial femoral head replacement group(replacement group)and PFNA-II internal fixation group(internal fixation group). The two groups were compared with the operation conditions(operation time,blood loss during the perioperative period), postoperative Harris score,days of hospitalization,first time to the ground,full weight-bearing time,and complications. Results The operative time and perioperative bleeding in the replacement group were significantly more than in the internal fixation group(P0.05). The number of days of hospitalization,first time to go to the ground,and complete weight-bearing time in the replacement group were significantly shorter than those in the internal fixation group(P0.05). Conclusion The two surgical methods have good curative effect on elderly patients with unstable IFF. PFNA-II internal fixation is suitable for most elderly unstable IFF,while artificial femoral head replacement is suitable for severe osteoporosis or early patients with special requirements for functional rehabilitation exercises.
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