骨水泥加长柄人工股骨头置换对高龄严重 骨质疏松性股骨转子间骨折患者术后 活动能力和生活质量的影响

Effect of cemented long-stem artificial femoral head replacement on postoperative activity ability and quality of life in elderly patients with severe osteoporotic intertrochanteric fractures

摘要:

目的 探讨高龄严重骨质疏松性股骨转子间骨折患者采用骨水泥加长柄人工股骨头置换治疗对患 者术后活动能力和生活质量的影响。方法 选取2011 年7 月-2016 年8 月该院收治的50 例高龄股骨转子间 粉碎骨折患者资料做回顾性分析，根据医师建议以及患者意愿，分为对照组和治疗组。对照组22 例采用股骨 近端防旋髓内钉（PFNA）治疗，治疗组28 例采用骨水泥加长柄人工股骨头置换治疗。比较两组手术一般情 况，术后不同时间点Harris 髋关节功能评分、术后并发症以及术后不同时间点健康调查简表（SF-36）评分。 结果 治疗组手术时间、切口长度与对照组比较，差异有统计学意义（P <0.05），治疗组长于对照组；治疗组 术中出血量多于对照组，下床活动时间短于对照组，差异有统计学意义（P <0.05）；两组术中输血量比较，差 异无统计学意义（P >0.05）；治疗组术后1、3、6 个月Harris 评分与对照组比较，差异有统计学意义（P <0.05）， 治疗组高于对照组，两组Harris 评分在术后12 个月比较，差异无统计学意义（P >0.05）；治疗组并发症发 病率为7.14%，对照组并发症发病率为27.27%，两组比较差异无统计学意义（P >0.05）；治疗组术后3 个月， SF-36 量表各维度评分高于对照组，差异有统计学意义（P <0.05），术后12 个月，SF-36 量表各维度评分与对 照组比较差异无统计学意义（P >0.05）。结论 相对于PFNA，加长柄人工股骨头置换治疗可有效缩短患者下 床活动时间，术后早期髋关节功能恢复较好，生活质量较高，对于伴有严重骨质疏松的高龄股骨转子间骨折患 者而言是较优选择。

Abstract:

Objective To explore the effect of cemented long-stem artificial femoral head replacement on postoperative activity ability and quality of life in elderly patients with severe osteoporotic intertrochanteric fractures. Methods The data of 50 cases of elderly patients with femoral intertrochanteric comminuted fractures in our hospital from July 2011 to August 2016 were selected for retrospective analysis, and the patients were divided into a control group and a treatment group according to physicians’ recommendations and patients’ wishes. The 22 patients of the control group were treated with proximal femoral nail anti-rotation (PFNA), and the 28 patients of the treatment group were given the cemented long-stem artificial femoral head replacement. The general conditions of operation,Harris hip function score at different postoperative time points, postoperative complications and the MOS 36-item Short Form Health Survey (SF-36) score at different postoperative time points were compared between the two groups. Results The operative time and incision length in the treatment group were longer than those in the control group (P < 0.05). And the intraoperative bleeding volume in the treatment group was larger than that in the control group while the off-bed activity time was shorter than that in the control group (P < 0.05). The blood transfusion volume was not significantly different between the two groups (P > 0.05). The Harris scores in the treatment group were higher than those in the control group at 1, 3 and 6 m after operation (P < 0.05), and the Harris score was not significantly different between the two groups at 12 m after operation (P > 0.05). The difference in the total incidence rate of complications was not significant between the two groups (7.14% vs. 27.27%, P > 0.05). The scores of each dimension of SF-36 scale in the treatment group were higher than those in the control group 3 m after operation (P < 0.05), but there was no significant difference in each dimension score of SF-36 scale between the two groups 12 m after operation (P > 0.05). Conclusions Compared with PFNA, the long-stem artificial femoral head replacement can effectively shorten the off-bed activity time with better recovery of hip function in the early stage and higher quality of life, it is a good choice for patients with severe osteoporotic femoral intertrochanteric fractures.