Comparison of effects between artificial joint replacement and proximal femoral nail anti-rotation for treatment of unstable intertrochanteric femoral fracture in elderly patients

doi:10.3969/j.issn.2095-4344.0031

Abstract

Abstract:

BACKGROUND: Both proximal femoral nail anti-rotation (PFNA) and joint replacement in treatment of intertrochanteric femoral fracture can guarantee early bed removal and reduce long-term bed complications, but there are still more controversies in the selection of indications for the two methods.

OBJECTIVE: To observe the differences in clinical effects of artificial joint replacement and PFNA in treatment of unstable intertrochanteric femoral fracture in elderly.

METHODS: Totally 56 patients with Evans-Jensen types III-V intertrochanteric femoral fracture aged older than 65 years were enrolled in this study. Follow-up was conducted for 12 months. 11 cases did not complete follow-up visit. Among the remaining 45 cases, 27 patients were treated with artificial joint replacement, and 18 patients were treated with PFNA. Operation time, intraoperative blood loss, and postoperative weight-bearing time were compared between the two groups. Postoperative hip function was compared using Harris score between both groups. Postoperative complications were evaluated by clinical and radiological manifestations in both groups within 1 year after surgery.

RESULTS AND CONCLUSION: (1) Operation time and postoperative weight-bearing time were shorter in artificial joint replacement group than in the PFNA group (t=5.596, t=14.142, P < 0.05). (2) At postoperative 1, 3 and 6 months, Harris score was significantly higher in the artificial joint replacement group than in the PFNA group (t=8.301, t=10.017, t=8.593, P < 0.05). Harris score was similar between the two groups at postoperative 1 year (t=1.541, P > 0.05). (3) The total incidence of complications was 22% in artificial joint replacement group and 23% in PFNA group; there were no statistical differences between the two groups (χ²=0.180, P > 0.05). (4) For elderly patients with unstable intertrochanteric femoral fracture, artificial joint replacement and PFNA can obtain satisfactory effect. The operation time of artificial joint replacement is short, and early weight-bearing contributes to reducing long-term bed complications.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Hip Fractures, Arthroplasty, Replacement, Hip, Tissue Engineering

CLC Number:

R318

Lan Tian, Shan Zhan, Wu Jin-chun. Comparison of effects between artificial joint replacement and proximal femoral nail anti-rotation for treatment of unstable intertrochanteric femoral fracture in elderly patients[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(3): 362-367.

Figures/Tables 1

2.1 参与者数量分析纳入患者56例，分为2组，失访11例，完成随访的45例进入结果分析。患者分组流程图见图1。 2.2 两组患者基线资料分析见表1。 2.3 临床指标比较相比较关节置换组，股骨近端防旋髓内钉组手术时间较长，且术后下床负重时间较长，差异均有显著性意义(P < 0.05)。两组在术中出血量方面相近，结果差异无显著性意义(P > 0.05)。见表2。 2.4 Harris功能评分术后髋关节功能评价采用Harris评分标准，对术后1，3，6，12个月两组髋患者进行评分。结果显示在术后1，3，6个月时，两组差异有显著性意义 (P < 0.05)，关节置换组获得更好的功能。而术后12个月则两组评分差异无显著性意义(P > 0.05)，见表3。 2.5 并发症发生情况根据患者术后1年内出现并发症的情况，分别观察非内置物相关并发症(切口感染、深静脉血栓形成、肺部感染、泌尿系感染、压疮)和内置物相关并发症(骨折不愈合、内固定松动移位、人工关节脱位、假体周围骨折)，结果见表4。非内置物相关并发症方面：关节置换组出现1例下肢深静脉血栓、1例肺部感染、1例泌尿系感染、1例切口浅部感染；股骨近端防旋髓内钉组出现1例下肢深静脉血栓、1例压疮，关节置换组非内置物相关并发症发生率较高，但统计学分析差异无显著性意义(P > 0.05)。内置物相关并发症方面：关节置换组出现1例术后早期假体脱位，复位后维持外展外旋3周，未再次脱位，1例假体周围异位骨化，关节活动度受限；股骨近端防旋髓内钉组出现3例螺旋刀片部分退出以达到二次稳定，所有骨折均顺利愈合。两组患者1年内均无死亡。 2.6 典型病例介绍例1：患者男，77岁，左股骨转子间骨折(Evans-Jensen Ⅳ型，图2A)，行左股骨近端防旋髓内钉内固定术，术后于2014-11-02拍摄X射线片，图2B显示术后骨折复位良好，股骨近端防旋髓内钉内固定位置佳。例2：患者女，89岁，右股骨转子间骨折(Evans-Jensen Ⅴ型，图3A)，行右人工股骨头置换术，术后于2014-10-27拍摄X射线片，图3B显示术后大小转子已复位并钢丝捆扎固定，骨水泥固定型人工假体位置良好。"

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