Comparison of the Efficacy of Prosthetic Femoral Head Replacement and PFNA in the Treatment of Elderly Femoral Neck Base Fracture
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.
Femoral Neck Base Fracture
股骨颈骨折好发于骨质疏松的老年人
选择2019年1月~2023年3月收住院75岁以上股骨颈基底骨折患者60例。骨折原因：自己跌倒外伤58例，车辆事故外伤2例。人工股骨头置换组30例，男性11例，女性19例，年龄75~96岁，平均83.2岁，治疗方式采用人工股骨头置换治疗PFNA内固定组30例，男13例，女17例，年龄75~94 岁，平均81.5岁，治疗方式采用PFNA内固定治疗。
人工股骨头置换：麻醉成功后，选择健侧卧位，取髋外侧切口，切开阔筋膜后，将臀中肌前1/3锐性向前剥离股骨转子部，打开关节囊，暴露股骨头，并取出测量大小，切除髋臼的圆韧带残端。扩髓腔至合适大小，特别注意用力轻柔，避免股骨近端骨折，打入股骨柄假体，冲洗后试模，放入双极股骨头后复位冲洗，缝合切口。PFNA组：麻醉成功后，患者仰卧位于牵引床上，C臂机辅助下开展复位，复位效果满意后选择大转子顶端近侧做一纵向切口，切口长度大约4~5 cm，暴露大转子尖端，置入导针后在髓腔近端开口，插入主钉，打入导针，测量深度，通过C臂机透视控制螺旋刀片尖部的位置，沿着导针打入螺旋刀片，安装远端定位器，拧入锁钉。
对比两组患者手术时间、术中出血量、术前、术后血常规情况、疼痛VAS评分、术后下肢髋开始活动时间、术后下地活动时间、术后并发症发生情况如下肢深静脉血栓(DVT)发生情况、创口情况、是否发生谵妄、术后3月、6月、1年生存情况、末次随访Harris评分。依据Harris标准评估两组术后髋关节功能恢复情况，总分100分，分值越高，提示患者髋关节功能越好。
数据采用SPSS 25.0统计学软件处理数据，计数资料以例(百分率)表示，行χ2检验；计量资料以x ± s表示，行t检验；P < 0.05差异有统计学意义。
对比两组住院时间、手术时间差异、围手术期出血监测无统计学意义(P > 0.05)，其他数据差异有统计学意义(P < 0.05)。
分别于术后2周、4周、8周、3月、6月及1年对两组患者进行髋关节Harris评分。两组术后Harris评分随时间推移均显著增加。两组患者术后2周和4周Harris评分股骨头置换组明显高于PFNA组，差异有统计学意义(P < 0.05)，术后8周及以后两组Harris评分差异无统计学意义。术后3月随访，两组均匀1名患者离世而失访，术后6月术后人工股骨头置换组1名患者离世，PFNA组2名患者离世。PFNA组：Harris评分优良者25例，较好者1例，优良率92.85%。股骨头置换组：Harris评分优良者27例，较好者1例，优良率为96.55%。两组患者术后１年优良率的差异无统计学意义(P > 0.05)。PFNA组患者术后2周内发生肌间静脉血栓3例，肺炎1例，骨折延迟愈合1例，1年后愈合，谵妄10例；股骨头置换组术后两周内发生肌间静脉血栓1例，发生创口感染1例，抗感染治疗后创口愈合，谵妄12例，但两组的并发症发生差异无统计学意义(P > 0.05)。
股骨颈骨折是临床常见的骨折类型，严重影响了老年人的生活质量。骨折患者多伴有多种内科疾病，保守治疗需长期卧床，更容易并发肺部感染、尿路感染、下肢静脉血栓等并发症，甚至危及生命
在实际中，我们更应该根据股骨颈基底骨折的年龄、一般情况及经济条件进行综合评估，根据个体化原则选择合适的手术方式
龙港市2023年社会(医学)类科技计划项目2023S01。