目的 探究两种手术方式(人工股骨头置换术、微创股骨近端防旋髓内钉)在骨质疏松性老年股骨近端骨折中的治疗效果.方法 方便选取2022年6月—2023年6月广东省雷州市人民医院收治的64例骨质疏松性老年股骨近端骨折患者为研究对象,根据随机数字表法分为人工组(人工股骨头置换术治疗)与微创组(微创股骨近端防旋髓内钉治疗),每组32例.两组均随访6个月,对比两组患者手术效果、髋关节功能与并发症发生情况.结果 微创组手术时间短于人工组,术中失血量少于人工组,术后卧床时间长于人工组,差异有统计学意义(P均<0.05).术前,两组患者Harris髋关节评分系统(Harris Hip Scoring System,HHS)评分比较,差异无统计学意义(P>0.05);术后4、8周两组患者HHS评分均升高,且人工组评分高于微创组,差异有统计学意义(P均<0.05).人工组并发症总发生率为18.75%,高于微创组的3.13%,差异有统计学意义(χ2=4.010,P=0.045).结论 骨质疏松性老年股骨近端骨折均可应用微创股骨近端防旋髓内钉与人工股骨头置换术治疗,其中,前者手术方案在术中效果更优,能够缩短手术时间,减少失血量,降低术后并发症;后者手术方案在患者术后恢复上效果较优,其可缩短患者术后卧床时间,提高HHS评分,故在临床中应结合患者病情状况及意愿选择合适的手术方式.
Comparison of Clinical Efficacy of Minimally Invasive Proximal Femoral Anti-rotation Intramedullary Nail and Artificial Femoral Head Replace-ment for Elderly Patients with Osteoporotic Proximal Femoral Fractures
Objective To explore the therapeutic effect of two surgical methods(artificial femoral head replacement and minimally invasive proximal femur anti-rotation intramedullary nail)in elderly patients with osteoporotic proximal femoral fractures.Methods 64 patients with osteoporotic proximal femoral fractures admitted to Leizhou People's Hos-pital of Guangdong Province from June 2022 to June 2023 were conveniently selected as the study objects,and were divided into artificial group(artificial femoral head replacement treatment)and minimally invasive group(minimally invasive proximal femoral anti-rotation intramedullary nail treatment)according to random number table method,with 32 cases in each group.Both groups were followed up for 6 months,and the operative effect,hip function and compli-cations were compared between the two groups.Results The operation time of minimally invasive group was shorter than that of artificial group,the intraoperative blood loss was less than that of artificial group,and the postoperative bed time was longer than that of artificial group,the differences were statistically significant(all P＜0.05).Before op-eration,there was no statistically significant difference in Harris Hip Scoring System(HHS)scores between the two groups(P＞0.05);HHS scores in both groups increased 4 and 8 weeks after surgery,and the scores in the artificial group were higher than those in the minimally invasive group,the differences were statistically significant(both P＜0.05).The total incidence of complications in the artificial group was 18.75%,higher than that in the minimally inva-sive group(3.13%),and the difference was statistically significant(χ2=4.010,P=0.045).Conclusion Both minimally invasive proximal femoral napping and artificial femoral head replacement can be used in the treatment of elderly pa-tients with osteoporotic proximal femoral fractures.Among them,the former has better operative effect,which can shorten operative time,reduce blood loss and reduce postoperative complications.The latter surgical plan has a better effect on postoperative recovery of patients,which can shorten the postoperative bed time of patients and improve the HHS score.Therefore,the appropriate surgical method should be selected according to the patient's condition and willingness in clinical practice.
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