本文關(guān)鍵詞：三種內(nèi)固定方法治療股骨轉(zhuǎn)子間骨折的臨床療效對(duì)比分析　出處：《鄭州大學(xué)》2016年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 亞洲型股骨近端抗旋髓內(nèi)釘(PFNA-Ⅱ) Gamma釘 Inter TAN釘 股骨轉(zhuǎn)子間骨折

【摘要】：目的對(duì)比三種內(nèi)固定PFNA-Ⅱ(亞洲型股骨近端抗旋髓內(nèi)釘)、Gamma釘、Inter TAN釘治療股骨轉(zhuǎn)子間骨折的臨床效果,為以后的股骨轉(zhuǎn)子間骨折的手術(shù)治療提供相對(duì)有效的參考數(shù)據(jù)。方法回顧性分析鄭大一附院骨外科自2011年11月至2015年1月手術(shù)治療股骨轉(zhuǎn)子間骨折的85例病人,女性40例,男性45例,年齡最大89歲,最小41歲,平均65.8歲,所有患者入院后均拍攝雙髖標(biāo)準(zhǔn)正位片及患髖側(cè)位片,按AO分型,A1型30例,A2型32例,A3型23例,其中采用PFNA-Ⅱ固定35例,采用Gamma釘固定22例,采用Inter TAN釘固定28例,全是單側(cè)閉合性類(lèi)型的骨折。手術(shù)后對(duì)照評(píng)估三組患者手術(shù)的時(shí)間、手術(shù)中X線透視的次數(shù)、手術(shù)中出血量、術(shù)后負(fù)重時(shí)間、術(shù)后骨折愈合時(shí)間、術(shù)后并發(fā)癥、術(shù)后6個(gè)月髖關(guān)節(jié)Harris評(píng)分、術(shù)后12月髖關(guān)節(jié)Harris評(píng)分等8個(gè)維度應(yīng)用統(tǒng)計(jì)軟件進(jìn)行對(duì)照分析三種髓內(nèi)釘在股骨轉(zhuǎn)子間骨折手術(shù)治療的效果。結(jié)果三組的患者手術(shù)都順利完成,均得到12-18個(gè)月的術(shù)后隨訪,平均隨訪時(shí)間為13.1個(gè)月,且無(wú)一失訪。三組患者手術(shù)時(shí)間的比較:PFNA-Ⅱ組時(shí)間為52.20±12.8min,Gamma釘組時(shí)間為76.24±15.3min,Inter TAN組時(shí)間為61.23±10.05min三組患者手術(shù)時(shí)間的差異具有統(tǒng)計(jì)學(xué)意義(P0.05),其中用時(shí)間最短的為PFNA-Ⅱ組,其次為Inter TAN組,用時(shí)最多的是Gamma釘組;三組術(shù)中X線透視次數(shù)的比較:PFNA-Ⅱ組次數(shù)為8.60±1.1次,Gamma釘組時(shí)間為12.10±0.80次,Inter TAN組時(shí)間為8.40±0.90次,PFNA-Ⅱ組、Inter TAN組分別與Gamma釘組比較患者術(shù)中透視次數(shù)的差異具有統(tǒng)計(jì)學(xué)意義(P0.05),但PFNA-Ⅱ組和Inter TAN組兩組相比較,患者術(shù)中透視次數(shù)無(wú)統(tǒng)計(jì)學(xué)差異(PO.05);三組患者術(shù)中出血量的比較:PFNA-Ⅱ組的出血量為96.80±58.40ml,Gamma釘組時(shí)間為152.30±108.60ml,Inter TAN組時(shí)間為116.23±43.55ml,三組患者術(shù)中出血量的差異具有統(tǒng)計(jì)學(xué)意義(P0.05),其中出血量最少的為PFNA-Ⅱ組,其次為Inter TAN組,出血量最多的是Gamma釘組;三組患者術(shù)后骨折愈合時(shí)間的比較:PFNA-Ⅱ組的愈合時(shí)間為13.40±3.10周,Gamma釘組愈合時(shí)間為14.20±3.20周,Inter TAN組時(shí)間為11.10±2.50周,PFNA-Ⅱ組、Gamma釘組分別與Inter TAN組比較患者術(shù)后骨折愈合時(shí)間的差異具有統(tǒng)計(jì)學(xué)意義(P0.05),Inter TAN組的愈合需要時(shí)間最短,但PFNA-Ⅱ組和Gamma釘組兩組相比較,患者術(shù)后骨折愈合時(shí)間無(wú)統(tǒng)計(jì)學(xué)差異(PO.05);三組患者術(shù)后負(fù)重時(shí)間比較:PFNA-Ⅱ組的負(fù)重時(shí)間為41.55±22.52d,Gamma釘組負(fù)重時(shí)間為40.89±20.94d,Inter TAN組負(fù)重時(shí)間為40.15±28.04d,三組患者術(shù)后負(fù)重時(shí)間無(wú)統(tǒng)計(jì)學(xué)差異(PO.05);三組患者術(shù)后6個(gè)月Harris評(píng)分比較中,PFNA-Ⅱ組、Gamma釘組分別與Inter TAN組比較患者術(shù)后6個(gè)月Harris評(píng)分的差異具有統(tǒng)計(jì)學(xué)意義(P0.05),Inter TAN組的評(píng)分最高,但PFNA-Ⅱ組和Gamma釘組兩組相比較,患者術(shù)后6個(gè)月Harris評(píng)分無(wú)統(tǒng)計(jì)學(xué)差異(PO.05);在術(shù)后12個(gè)月Harris評(píng)分上三者無(wú)明顯的差別。三組患者術(shù)后并發(fā)癥上的比較:所有被隨訪的患者都沒(méi)有出現(xiàn)死亡、骨折延遲愈合、頭頸短縮、髖內(nèi)翻、股骨干骨折、內(nèi)固定物周?chē)钦�、�?nèi)固定物失效及斷裂、切口感染、切口不愈合、肺栓塞、褥瘡等并發(fā)癥,三組患者術(shù)后并發(fā)癥發(fā)生率差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論1、在治療股骨轉(zhuǎn)子間骨折時(shí),PFNA-Ⅱ、Gamma釘、Inter TAN釘這三種髓內(nèi)釘都有較好的療效,其中在術(shù)后下地負(fù)重時(shí)間、術(shù)后12個(gè)月Harris評(píng)分及術(shù)后并發(fā)癥上三者無(wú)明顯的差別,因此三種手術(shù)方式都可以盡可能的早期鍛煉,縮短恢復(fù)時(shí)間,減少并發(fā)癥的發(fā)生;2、PFNA-Ⅱ和其他兩組相比在手術(shù)時(shí)間較短和術(shù)中出血量較少,減輕了患者的“二次打擊”,盡可能減少創(chuàng)傷。且PFNA-Ⅱ組和Inter TAN釘組的術(shù)中透視次數(shù)少,從而大大減輕輻射對(duì)患者的危害,也對(duì)醫(yī)護(hù)工作者也有了很大的保護(hù)作用;Inter TAN釘組相比其他兩組的優(yōu)勢(shì)在術(shù)后骨折愈合時(shí)間較短和術(shù)后6個(gè)月Harris評(píng)分較高,因而早期的愈合有較大的優(yōu)勢(shì)。
[Abstract]:Objective to compare the three kinds of internal fixation of PFNA- (Asian proximal femoral nail anti rotation), Gamma nail, clinical effect of treatment of intertrochanteric fractures of Inter TAN nail, femur after fracture between surgical treatment and provide reference data relatively effective. Methods a retrospective analysis of the 1st Affiliated Hospital of Zhengzhou University from November 2011 to January 2015 in bone surgery surgical treatment of femoral intertrochanteric fractures in 85 patients, 40 cases were female, 45 were male, age biggest 89 years old, the minimum age of 41, with an average of 65.8 years. All patients were admitted to the hospital from hip standard anteroposterior and lateral radiographs of the hip, according to AO classification, 30 cases of type A1, 32 cases of A2 type, 23 cases of type A3, which uses PFNA- II 35 cases were fixed with Gamma nails, 22 cases were fixed with Inter and TAN nail fixation in 28 cases, all closed unilateral type fractures. Evaluation of three groups of patients with operation time after surgery, intraoperative fluoroscopy times, the amount of bleeding during operation, Postoperative weight-bearing time, fracture healing time after operation, postoperative complications, postoperative Harris hip score at 6 months, compared with three kinds of intramedullary nails in the effect of surgical treatment of intertrochanteric fractures of the femur in December Harris hip score of 8 dimensions using statistical software after surgery. Results three patients surgery successfully completed, were 12-18 months of follow-up, the mean follow-up time was 13.1 months, and no one lost. Compared three groups of patients with operation time: PFNA- group II time was 52.20 + 12.8min, Gamma nail group time was 76.24 + 15.3min, Inter TAN 61.23 + 10.05min group time difference of three groups of patients the operation time was statistically significant (P0.05), one of the shortest time for the PFNA- II group, followed by Inter TAN group, with most of the Gamma nail group; compare the X-ray fluoroscopy number of the three groups: PFNA- group II number is 8.60 + 1.1, Gamma nail group was 1 2.10 + 0.80, Inter group TAN time was 8.40 + 0.90, PFNA- II group, Inter TAN group and Gamma group compared with the difference of nail fluoroscopy during operation in patients with statistical significance (P0.05), but the PFNA- II group and Inter TAN group compared two groups of patients with intraoperative fluoroscopy times had no statistical difference (PO.05); compare the amount of bleeding in the three groups: the amount of bleeding of PFNA- group was 96.80 + 58.40ml, Gamma nail group time was 152.30 + 108.60ml, Inter of TAN group was 116.23 + 43.55ml, the difference was statistically significant amount of bleeding in the three groups (P0.05), one of the least amount of bleeding PFNA- II group, followed by Inter TAN group, the amount of bleeding is the most Gamma nail group; compare the fracture healing time of three groups of patients: PFNA- II Group healing time was 13.40 + 3.10 weeks, Gamma nail group healing time was 14.20 + 3.20 weeks, Inter TAN group time was 11.10 + 2.50 weeks. PFNA- II group, Gam Ma nail group and Inter TAN group compared with postoperative fracture healing time was statistically significant difference (P0.05), Inter TAN group healing time is short, but the PFNA- group and Gamma nail group compared the two groups, there was no significant difference in fracture healing time after surgery (PO.05); comparison of loading time of patients the three groups after surgery: PFNA- II group loading time was 41.55 + 22.52d, Gamma nail group loading time was 40.89 + 20.94d, Inter group TAN loading time was 40.15 + 28.04d, three groups of patients with postoperative weight-bearing time no statistical difference (PO.05); comparison of Harris score at 6 months after operation in the three groups, PFNA- in group II, with statistical significance Gamma nail group and Inter TAN group of patients after 6 months Harris score difference (P0.05), Inter TAN group was the highest, but the PFNA- group and Gamma nail group, compared two groups of patients after 6 months Harris score was no significant difference (P O.05); in 12 months after surgery, Harris score of three had no obvious difference. The complications between the three groups of patients with postoperative follow-up: all patients had no death, delayed fracture healing, short neck, hip varus, femoral shaft fracture, periprosthetic fracture, internal fixation failure and fracture, incision infection, incision healing, pulmonary embolism, bedsore and other complications of postoperative complications in the three groups had no statistically significant difference in the incidence rate of 1. In conclusion, the treatment of intertrochanteric fracture, PFNA- II, Gamma nail, Inter nail TAN these three kinds of intramedullary nails have good curative effect, the postoperative under the loading time, there is no significant difference between Harris scores at 12 months after surgery and postoperative complications in three, so three kinds of operation can be as much as possible early exercise, shorten recovery time, reduce the incidence of complications; 2, PFNA- II and compared to the other two groups in the operation time is Short and less bleeding, reduce the patient's "two hit", as far as possible to reduce trauma. And the perspective PFNA- II group and Inter TAN nail group intraoperative number, thus greatly reduce the radiation harm to patients, but also for medical workers also have a great protective effect; Inter TAN nail group compared to the other two groups the advantages of shorter recovery time and postoperative 6 months Harris score higher in the postoperative fracture, thus early healing has a greater advantage.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R687.3

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本文編號(hào)：1379119