Objective:To explore the the effect of artificial femoral head replacement (AFHR) and proximal femoral nail anti rotation (PFNA) internal fixation in the treatment of elderly patients with intertrochanteric femoral fracture (IFF).Methods:A total of 102 elderly patients with IFF,who were treated in 174th Hospital of PLA from March 2010 to October 2016,were selected and randomly divided into AFHR group (51 cases) and PFNA group (51 cases).The general situation of operation (including operation time,intraoperative blood loss,ambulation time,full weight-bearing time,the postoperative hospital stay) was compared between the two groups.The hip function score was evaluated by Harris scoring system before operation and 3,6,12 months after operation;the mortality and complications were observed.Results:The operation time and intraoperative blood loss of PFNA group was less than that of AFHR group,ambulation time and full weight-bearing time was more than that of AFHR group,the difference was statistically significant (P＜0.05),there was no significant difference in postoperative hospital stay between the two groups (P＞0.05).There were no significant differences in Harris scores before operation,6 months,and 12 months after operation between the two groups (P＞0.05);3 months after operation,the Harris score of AFHR group was higher than that of PFNA group,and the Harris scores of the two groups were higher than those before treatment,the difference was statistically significant (P＜0.05).The mortality and complication rates in PFNA group were 0.00％ and 5.88％,compared with 1.96％ and 9.80％ in AFHR group,the difference was not statistically significant (P＞0.05).Conclusion:In the surgical treatment of elderly patients with IFF,PFNA intemal fixation has the advantages of shorter operation time and less blood loss during operation.After AFHR,the patients can perform functional exercise early,and the function of hip joint can recover quickly.%目的:探讨人工股骨头置换术(AFHR)与股骨近端防旋髓内钉(PFNA)内固定治疗老年股骨转子间骨折(IFF)患者的疗效.方法:选择2010年3月至2016年8月本院收治的老年IFF患者102例为研究对象,采用随机数字表法分为AFHR组(n=51)和PFNA组(n=51),比较两组手术一般情况(包括手术时间、术中出血量、下地活动时间、完全负重时间、术后住院时间),术前与术后第3、6、12个月采用Harris评分量表对患者进行髋关节功能评分,观察术后病死率及并发症的发生情况.结果:PFNA组手术时间、术中出血量少于AFHR组,下地活动时间、完全负重时间多于AFHR组,差异有统计学意义(P＜0.05),两组术后住院时间比较差异无统计学意义(P＞0.05).两组患者术前、术后6个月、术后12个月Harris评分比较差异无统计学意义(P＞o.05),术后3个月AFHR组患者Harris评分高于PFNA组,且两组患者术后Harris评分较治疗前均升高,差异有统计学意义(P＜o.05).PFNA组病死率和并发症发生率分别为0.00％和5.88％,与AFHR组的1.96％和9.80％比较,差异无统计学意义(P＞0.05).结论:在老年IFF的手术治疗中,PFNA内固定具有手术时间短、术中出血量少的优势,AFHR后患者可早期进行功能锻炼,术后髋关节功能恢复快.
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