人工股骨头置换与PFNA治疗老年股骨颈基底骨折的疗效对比
Comparison of the Efficacy of Prosthetic Femoral Head Replacement and PFNA in the Treatment of Elderly Femoral Neck Base Fracture

目的：对比人工股骨头置换术与PFNA (股骨近端防旋髓内钉)治疗老年股骨颈基底骨折的疗效。方法：回顾性分析自2019年1月~2023年3月手术治疗的60例年龄 ≥ 75岁股骨颈基底骨折，采用人工股骨头置换术治疗30例。采用PFNA内固定治疗30例。与PFNA组比较，置换组术后至下床时间更短，术后1周疼痛VAS评分更低，术后1、3个月髋关节功能Harris评分更高，但切口更长，术中出血量更多，差异有统计学意义(P < 0.05)。PFNA组与置换组围手术期出血量，手术时间、住院时间、术后6个月髋关节功能Harris评分比较差异无统计学意义(P > 0.05)。结论：人工股骨头置换术治疗老年股骨颈基底骨折具有术后下地时间早、去辅助时间早、疼痛缓解及早期髋关节功能良好等优点，但手术创伤大。PFNA内固定治疗老年股骨颈基底骨折小切口、术中出血少等优点，但术后髋关节功能恢复更慢，总失血量差别不大，因此需要依照患者的具体需求及疾病特点选择最佳的手术方式，从而保证手术治疗效果。
Objective: To compare the efficacy of artificial femoral head replacement and PFNA (proximal femoral anti-rotation intramedullary nail) in the treatment of elderly femoral neck base fracture. Methods: A retrospective analysis was performed on 60 cases of femoral neck base fracture aged ≥ 75 years from January 2019 to March 2023, and 30 cases were treated with artificial femoral head replacement. 30 cases were treated with PFNA internal fixation. Compared with PFNA group, the replacement group had shorter postoperative time to getting out of bed, lower pain VAS score 1 week after surgery, and higher hip function Harris score 1 and 3 months after surgery, but the incision was longer and the intraoperative blood loss was more, the difference was statistically significant (P < 0.05). There was no significant difference between PFNA group and replacement group in perioperative blood loss, operation time, hospital stay and Harris score of hip function 6 months after operation (P > 0.05). Conclusion: Artificial femoral head replacement in the treatment of elderly femoral neck base fracture has the advantages of early implantation time, early assisted time, pain relief and early hip function, but the operation is more traumatic. PFNA internal fixation in the treatment of elderly femoral neck base fracture has the advantages of small incision and less intraoperative bleeding, but the postoperative hip function recovery is slower and the total blood loss is not different. Therefore, it is necessary to select the best surgical method according to the specific needs of patients and disease characteristics, so as to ensure the surgical treatment effect.