人工股骨头置换术与闭合复位内固定术治疗老年骨质疏松不稳定型股骨转子间骨折的疗效比较OA
Comparison of the efficacy of artificial femoral head replacement and closed reduction and internal fixation in the treatment of unstable femoral intertrochanteric fracture in the elderly with osteoporosis
目的 基于倾向评分匹配(propensity score matching,PSM)方法,比较人工股骨头置换术(artificial femoral head replacement,AFHR)与闭合复位内固定术(closed reduction and internal fixation,CRIF)治疗老年骨质疏松不稳定型股骨转子间骨折的临床疗效.方法 回顾性分析2023年1月至2025年6月嘉兴市第一医院收治的128例老年骨质疏松不稳定型股骨转子间骨折患者的临床资料,根据治疗方案将其分为观察组(52例)和对照组(76例).采用PSM按1∶1比例匹配,均衡治疗前混杂因素,最终两组各有52例匹配成功.观察组行AFHR治疗,对照组行CRIF治疗,随访6个月.比较两组患者的一般资料、手术相关指标、疗效、关键结局及并发症发生情况.结果 PSM后两组患者的一般资料比较差异无统计学意义(P>0.05).观察组患者的手术时间显著长于对照组、术中出血量显著多于对照组,住院时间显著短于对照组(P<0.05).观察组患者的优良率显著高于对照组,并发症总发生率显著低于对照组(P<0.05);两组患者的死亡率、再手术率、内固定失败率、假体脱位率和输血率比较差异均无统计学意义(P>0.05).结论 AFHR治疗老年骨质疏松不稳定型股骨转子间骨折虽手术时间更长、术中出血量更多,但可显著提高临床疗效,降低并发症发生率,安全性更优.
Objective Based on the propensity score matching(PSM)method,the clinical efficacy of artificial femoral head replacement(AFHR)and closed reduction and internal fixation(CRIF)in the treatment of unstable femoral intertrochanteric fracture in the elderly with osteoporosis was compared.Methods A retrospective analysis was conducted on the clinical data of 128 elderly patients with osteoporosis and unstable femoral intertrochanteric fracture admitted to the First Hospital of Jiaxing from January 2023 to June 2025.According to the treatment plan,they were divided into observation group(52 cases)and control group(76 cases).PSM was matched at a 1∶1 ratio to balance the confounding factors before treatment.Eventually,52 cases were successfully matched in each of two groups.The observation group received AFHR treatment,while the control group received CRIF treatment.They were followed up for 6 months.The general information,surgery-related indicators,therapeutic effects,key outcomes and the occurrence of complications of two groups were compared.Results There was no statistically significant difference in the general data of two groups of patients after PSM(P>0.05).The operation time of patients in observation group was significantly longer than that in control group,the intraoperative blood loss was significantly more than that in control group,and the hospital stay was significantly shorter than that in control group(P<0.05).The excellent and good rate of patients in observation group was significantly higher than that in control group,and the total incidence of complications was significantly lower than that in control group(P<0.05).There were no statistically significant differences in the mortality rate,reoperation rate,internal fixation failure rate,prosthesis dislocation rate and blood transfusion rate between two groups of patients(P>0.05).Conclusion Although AFHR treatment for unstable femoral intertrochanteric fracture in the elderly with osteoporosis has a longer operation time and more intraoperative blood loss,it can significantly improve clinical efficacy,reduce the incidence of complications,and has better safety.
朱红艳;沈丹萍;钟伟英;陈思慧;杨红娟;谢国庆
嘉兴大学附属医院(嘉兴市第一医院)骨科,浙江 嘉兴 314000嘉兴大学附属医院(嘉兴市第一医院)骨科,浙江 嘉兴 314000嘉兴大学附属医院(嘉兴市第一医院)骨科,浙江 嘉兴 314000嘉兴大学附属医院(嘉兴市第一医院)骨科,浙江 嘉兴 314000嘉兴大学附属医院(嘉兴市第一医院)骨科,浙江 嘉兴 314000嘉兴大学附属医院(嘉兴市第一医院)骨科,浙江 嘉兴 314000
医药卫生
人工股骨头置换术闭合复位内固定术老年骨质疏松不稳定型股骨转子间骨折疗效
Artificial femoral head replacementClosed reduction and internal fixationElderlyOsteoporosisUnstable femoral intertrochanteric fractureEfficacy
《中国现代医生》 2026 (22)
5-8,4
浙江省中医药科技计划项目(2022ZB354)
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