本文關(guān)鍵詞： 股骨粗隆間骨折 DHS PFNA 療效　出處：《湖北中醫(yī)藥大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：目前我國(guó)60歲以上老年人已達(dá)人口總數(shù)的10%以上，標(biāo)志著我國(guó)已經(jīng)步入老年化社會(huì)，老年髖部骨折的發(fā)病率逐漸升高，其中發(fā)病人數(shù)最多的為股骨粗隆間骨折，手術(shù)治療為臨床上最為主要的治療手段，PFNA和DHS是常見(jiàn)的兩種手術(shù)方法，本文主要探討以上兩種手術(shù)方法臨床優(yōu)缺點(diǎn)。 資料與方法:一般資料：回顧性分析湖北省中醫(yī)院骨傷科及武漢大學(xué)人民人民醫(yī)院骨外二科自2012年6月到2013年12月確診的股骨粗隆間骨折患者，患者的發(fā)病年齡一般為60歲以上，總計(jì)108例，按照內(nèi)固定方式不同分為兩個(gè)治療組；兩組患者均采用Evan-Jensen進(jìn)行骨折的分型；一組采用PFNA手術(shù)方式，總共有56例患者；男性、女性病例數(shù)分別為30、26，其中左側(cè)31例、右側(cè)25例，平均患病年齡為64.3歲，I~V型骨折患者病例數(shù)分別為：22、18、10、6、0；另一組照組患者采用DHS手術(shù)方式，一共有52例患者，男性和女性病例數(shù)分別為30、26，其中左側(cè)30例、右側(cè)22例，平均患病年齡為65.4歲；Evan-Jensen分型，其中I型有23例，，II型有19例，III有7例，IV型有4例，V型0例。 治療方法：兩組患者均行拍片和CT檢查確診，了解骨折情況，收住院后兩組患者均給予牽引治療，術(shù)前完善相關(guān)檢查，治療患者內(nèi)科原發(fā)疾病，患者全身情況調(diào)整至手術(shù)需求，一般骨折后3-7天行手術(shù)治療。兩組患者一般行硬脊膜外麻醉，分別采用PFNA、DHS兩種手術(shù)方法，術(shù)后一般常規(guī)給予第一代頭孢抗生素抗炎治療2-3天，促進(jìn)骨折愈合治療7-14天左右，傷口常規(guī)、定期予以換藥，傷口一般12天左右拆線，術(shù)后半月、一個(gè)月、三個(gè)月行X線復(fù)查并指導(dǎo)其功能鍛煉及營(yíng)養(yǎng)指導(dǎo)。 結(jié)果：兩組108例患者均無(wú)死亡病例，術(shù)后均獲得隨訪，隨訪時(shí)間為半年。兩組患者發(fā)病年齡、骨折分型等情況基本相同，無(wú)統(tǒng)計(jì)學(xué)意義，具有可比性。PFNA組患者平均手術(shù)出血量263±17ml，平均手術(shù)時(shí)間62.2±21.2分鐘，手術(shù)切口平均長(zhǎng)度8.52cm，平均骨折愈合時(shí)間90.2天，術(shù)中X線平均透視次數(shù)11.6次，術(shù)后Harris髖關(guān)節(jié)評(píng)分優(yōu)良率87.5%；術(shù)后發(fā)生髖內(nèi)翻1例，感染2例，術(shù)后總并發(fā)癥發(fā)生率5.3%；而DHS組患者平均手術(shù)出血量385±25ml，平均手術(shù)時(shí)間101.6±17.3分鐘，手術(shù)切口平均長(zhǎng)度18.4cm，平均骨折愈合時(shí)間118.5天，術(shù)中X線平均透視次數(shù)5.2次，術(shù)后Harris髖關(guān)節(jié)評(píng)分優(yōu)良率67.3%；術(shù)后發(fā)生髖內(nèi)翻8例、內(nèi)固定松動(dòng)4例、感染4例、壓瘡6例，術(shù)后總并發(fā)癥發(fā)生率42.3%。兩組患者對(duì)比有明顯差異性（P＜0.05），具有統(tǒng)計(jì)學(xué)意義。 結(jié)論：骨折后的良好復(fù)位和復(fù)位后給予堅(jiān)強(qiáng)和穩(wěn)固的內(nèi)固定可以使股骨粗隆間骨折早日愈合，可以減短患者因骨折而長(zhǎng)期臥床的時(shí)間，極大降低了因臥床時(shí)間長(zhǎng)而導(dǎo)致的并發(fā)癥的發(fā)生。PFNA是目前臨床運(yùn)用逐漸增多的新型內(nèi)固定裝置，該內(nèi)固定裝置的形態(tài)和結(jié)構(gòu)根據(jù)人體股骨解剖形態(tài)和力學(xué)特點(diǎn)而設(shè)計(jì)的是使股骨頭、頸部的剪切力減小和抗旋力增強(qiáng)。與此同時(shí)PFNA組患者術(shù)中出血量和術(shù)后并發(fā)癥要明顯低于DHS治療組患者，術(shù)后恢復(fù)情況優(yōu)良率明顯高于DHS組患者。故股骨粗隆間骨折一旦確診在無(wú)明顯手術(shù)禁忌癥的情況下，應(yīng)該早日安排手術(shù)，手術(shù)后指導(dǎo)患者早期進(jìn)行患側(cè)肢體的功能恢復(fù)，視恢復(fù)的情況盡可能早的讓患者下床活動(dòng)，這樣就可以減少臥床導(dǎo)致的并發(fā)癥，減輕患者痛苦，經(jīng)兩種方法比較發(fā)現(xiàn)PFNA治療股骨粗隆間骨手術(shù)具有手術(shù)時(shí)間短，創(chuàng)傷小，固定牢靠，術(shù)后并發(fā)癥少等優(yōu)點(diǎn)更值得臨床應(yīng)用。
[Abstract]:Objective: to present our elderly over the age of 60 has reached 10% of the total population, indicates that China has entered the aging society, the elderly hip fracture incidence increased gradually, one of the largest number of disease for intertrochanteric fractures, surgical treatment is the main treatment is the most clinically, PFNA and DHS is the two kind of common surgical method, this paper mainly discusses the above two kinds of operative methods for clinical advantages and disadvantages.
Materials and methods: the general data: a retrospective analysis of Hubei Provincial Traditional Chinese Medical Hospital of Wuhan University and the people's Hospital of orthopedics bone outside the two from June 2012 to December 2013 diagnosed patients with femoral intertrochanteric fracture, the age of patient is generally over the age of 60, a total of 108 cases, according to the different internal fixation methods, the patients were divided into two groups; type two all patients with Evan-Jensen fractures; a group using the PFNA procedure, a total of 56 patients were male, female; the number of cases were 30,26, 31 cases in the left and right side in 25 cases, the average age was 64.3 years, the number of cases of type I~V fracture patients were 22,18,10,6,0 DHS operation; another group group of patients with a total of 52 patients, male and female cases were 30,26, 30 cases in the left and right side in 22 cases, the average age was 65.4 years; the Evan-Jensen type, I type 23 cases, There were 19 cases of type II, 7 cases of III, 4 cases of IV type and 0 cases of V type.
Treatment methods: two patients underwent X-ray and CT examinations, understanding of fracture, admitted to hospital after two groups of patients were given traction treatment, perfect preoperative examination, medical treatment of patients with primary disease, adjust the general condition of the patients to surgery, surgery is generally 3-7 days after fracture. Two groups of patients with general hard line the epidural anesthesia, respectively PFNA, DHS two kinds of operative methods, postoperative general routine first generation cephalosporin antibiotic anti-inflammatory treatment 2-3 days, 7-14 days for promoting fracture healing, wound routine, regularly wound dressing, usually about 12 days after take out stitches, half a month, three months for X-ray review and guide the functional exercise and nutrition guidance.
Results: two groups of 108 patients were no deaths, all the cases were followed up for six months. The two groups of patients age, fracture type, the situation is basically the same, no statistically significant, with comparable average surgical patients in the.PFNA group the amount of bleeding was 263 + 17ml, the average operation time was 62.2 + 21.2 minutes, the average incision length was 8.52cm, the average healing time of 90.2 days, the average intraoperative X-ray fluoroscopy times 11.6, postoperative Harris hip score good rate of 87.5%; 1 cases of postoperative hip varus occurred in 2 cases, infection, postoperative complication rate was 5.3%; while the average amount of bleeding in operation group DHS 385 + 25ml, the average operation time was 101.6 + 17.3 minutes, the average incision length was 18.4cm, the average healing time of 118.5 days, the average intraoperative X-ray fluoroscopy times 5.2, postoperative Harris hip score good rate of 67.3%; 8 cases of postoperative hip varus, internal fixation loosening in 4 cases, There were 4 cases of infection and 6 cases of pressure sore. The incidence of total complications after operation 42.3%. two groups was significantly different (P < 0.05), with statistical significance.
Conclusion: after fracture reduction and reduction after giving strong and stable fixation can make the early healing of femoral intertrochanteric fracture, which can shorten the patients because of fracture bedridden time, greatly reducing the incidence of.PFNA caused by the long bed time of complications is a new type of internal fixation for the current clinical application of gradually increasing. The morphology and structure of the internal fixation device according to the human femur anatomy and mechanical characteristics and is designed to make the femoral head, neck and enhance the shear stress decreases anti rotation force. At the same time the amount of bleeding and postoperative complications of patients in the PFNA group was significantly lower than that in DHS treated patients, postoperative recovery was significantly higher than DHS groups of patients. The femoral intertrochanteric fracture in once diagnosed no surgical contraindications, should arrange an early surgery, after surgery to guide patients with early limb function Can recovery, as the recovery situation as early as possible to allow patients to get out of bed, so it can reduce the bed causing complications, alleviate the suffering of patients, through the comparison of two methods showed that PFNA treatment of intertrochanteric bone surgery with shorter operation time, less trauma, reliable fixation, postoperative complications more worthy of clinical application.

【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R687.3

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