發(fā)布時(shí)間：2018-01-16 17:16

  本文關(guān)鍵詞：老年股骨轉(zhuǎn)子間骨折PFNA術(shù)后復(fù)位丟失的原因分析　出處：《廣州中醫(yī)藥大學(xué)》2016年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 股骨轉(zhuǎn)子間骨折 復(fù)位丟失 防旋髓內(nèi)釘 危險(xiǎn)因素

【摘要】：目的：探討老年股骨轉(zhuǎn)子間骨折PFNA術(shù)后復(fù)位丟失的危險(xiǎn)因素,預(yù)測(cè)術(shù)后出現(xiàn)復(fù)位丟失的可能,指導(dǎo)進(jìn)一步的功能鍛煉,降低出現(xiàn)內(nèi)固定術(shù)后復(fù)位丟失的風(fēng)險(xiǎn)。方法：回顧性分析自2010年1月至2014年12月收治的86例老年股骨轉(zhuǎn)子間骨折患者的臨床資料,男37例,女49例；年齡60-94歲。以Baumgaertner復(fù)位質(zhì)量評(píng)價(jià)術(shù)后1周與術(shù)后12周前后兩次對(duì)比結(jié)果為判斷復(fù)位丟失等級(jí)的標(biāo)準(zhǔn)。其中復(fù)位丟失組27例(31.4%),非復(fù)位丟失組59例(68.6%)。收集患者的基本信息、骨折類(lèi)型、Singh指數(shù)、術(shù)前ASA評(píng)級(jí)、術(shù)后1周TAD、術(shù)后1周的復(fù)位質(zhì)量、術(shù)后12周的復(fù)位質(zhì)量、復(fù)位后股骨內(nèi)側(cè)小轉(zhuǎn)子骨塊移位等。采用Logistic回歸分析確定股骨轉(zhuǎn)子間骨折PFNA術(shù)后復(fù)位丟失的危險(xiǎn)因素。統(tǒng)計(jì)前后位及側(cè)位X光片螺旋刀片位置分布情況并分析其與復(fù)位丟失的關(guān)系。結(jié)果：復(fù)位丟失組與非復(fù)位丟失組比較臨床基線(xiàn)數(shù)據(jù)比較發(fā)現(xiàn),骨折類(lèi)型x 2=9.276,P=0.0260.05,說(shuō)明兩組之間骨折各類(lèi)型占有率之間差異有統(tǒng)計(jì)學(xué)意義；術(shù)后1周TAD指標(biāo)t=-4.354,P=0.0000.01,說(shuō)明兩組之間術(shù)后1周TAD差異有統(tǒng)計(jì)學(xué)意義；術(shù)后一周復(fù)位質(zhì)量x 2=11.216,P=0.0010.01,說(shuō)明兩組之間術(shù)后一周復(fù)位質(zhì)量人數(shù)比例差異有統(tǒng)計(jì)學(xué)意義；正位片中心位置釘區(qū)域x2=19.392,P=0.0000.01,說(shuō)明兩組組間的頭頸釘在股骨頭內(nèi)位置的比例差異有統(tǒng)計(jì)學(xué)意義；其余各指標(biāo)P值均大于0.05,說(shuō)明差異無(wú)統(tǒng)計(jì)學(xué)意義。Logistic單因素分析報(bào)告,骨折類(lèi)型、術(shù)后一周TAD、術(shù)后1周復(fù)位質(zhì)量、正位片中心位置釘區(qū)域四個(gè)指標(biāo)的P值小于0.05,說(shuō)明四個(gè)指標(biāo)與復(fù)位丟失之間的相關(guān)性具有統(tǒng)計(jì)學(xué)意義；性別、年齡、后股骨內(nèi)側(cè)小轉(zhuǎn)子骨塊移位、Singh指數(shù)、術(shù)前ASA評(píng)分5個(gè)指標(biāo)的P值均大于0.05,說(shuō)明五個(gè)指標(biāo)與復(fù)位丟失之間的相關(guān)性沒(méi)有統(tǒng)計(jì)學(xué)意義。Logistic多因素回歸分析報(bào)告,術(shù)后1周TAD、術(shù)后1周復(fù)位質(zhì)量、正位片中心位置釘區(qū)域?qū)?fù)位丟失的影響具有統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后1周TAD的OR=0.218,說(shuō)明TAD25mm更容易引起復(fù)位丟失,是TAD25mm引起復(fù)位丟失的4.6倍；術(shù)后1周復(fù)位質(zhì)量的OR=5.508,復(fù)位質(zhì)量為優(yōu)時(shí)是復(fù)位丟失的保護(hù)因素,說(shuō)明復(fù)位質(zhì)量為“可差”時(shí)導(dǎo)致復(fù)位丟失的危險(xiǎn)是復(fù)位質(zhì)量為“優(yōu)”時(shí)的5.5倍。正位片中心位置釘區(qū)域的OR=10.393,P=0.0000.01,具有統(tǒng)計(jì)學(xué)意義,表示正位片偏心位置置釘,即1號(hào)、4號(hào)區(qū)域是復(fù)位丟失的保護(hù)因素,在中心位區(qū)域置釘導(dǎo)致復(fù)位丟失的危險(xiǎn)是偏心位置釘?shù)?0.4倍；骨折類(lèi)型指標(biāo)的P值大于0.05,我們認(rèn)為在多因素分析中,對(duì)復(fù)位丟失的影響沒(méi)有統(tǒng)計(jì)學(xué)意義。結(jié)論：術(shù)中復(fù)位質(zhì)量根據(jù)Baumgaertner標(biāo)準(zhǔn)至少等級(jí)為良以上,股骨后內(nèi)側(cè)皮質(zhì)骨塊移位在5mm內(nèi)的可以不強(qiáng)求解剖復(fù)位,螺旋刀片尖頂距TAD值在25m以?xún)?nèi),合理置釘區(qū)域在BC區(qū),螺旋刀片尖端位于1號(hào)和4號(hào)區(qū)域。對(duì)于不穩(wěn)定型骨折(Ic、Id型)以及嚴(yán)重骨質(zhì)疏松患者,手術(shù)醫(yī)生更應(yīng)該嚴(yán)格要求以保證手術(shù)質(zhì)量,術(shù)后積極防治骨質(zhì)疏松,以降低發(fā)生術(shù)后復(fù)位丟失的風(fēng)險(xiǎn)系數(shù)。
[Abstract]:Objective: To investigate the risk of fracture after PFNA loss of reduction factors of senile intertrochanteric, loss of reduction may be predictive of postoperative functional exercise guidance, further, to reduce the risk of internal fixation after loss of reduction appeared. Methods: a retrospective analysis of the clinical data of 86 cases of femur in the elderly from January 2010 to December 2014 were patients with intertrochanteric fracture the male 37 cases, female 49 cases; age 60-94. Baumgaertner to reset quality evaluation after 1 weeks and 12 weeks after surgery before and after the two results to determine the loss of reduction rating standards. The loss of reduction group and 27 cases (31.4%), 59 cases of non loss reduction group (68.6%). The basic information. Collect the patients with fracture type, Singh index, preoperative ASA rating, TAD after 1 weeks of operation, the quality of reduction and 1 weeks after operation, the quality of reduction after 12 weeks, after the restoration of the medial femoral lesser trochanter bone displacement. Logistic regression analysis was used to determine the Risk of fracture after PFNA loss of reduction factor of femoral intertrochanteric. Statistical anteroposterior and lateral radiographs of X spiral blade position distribution and analysis of its relationship with the loss of reduction. Results: the loss of reduction and non reduction loss comparison group baseline clinical data, fracture type X 2=9.276, P=0.0260.05, that between the two groups each type of fracture was statistically significant difference between the share; t=-4.354, 1 weeks after operation P=0.0000.01 TAD index shows that, between the two groups was statistically significant difference after 1 weeks TAD; one week after operation, X 2=11.216 P=0.0010.01, the quality of reduction, said there were statistically significant differences in the quality of reduction ratio of the number of a week after surgery between the two groups; a center of nail area x2=19.392, P=0.0000.01, two groups of head and neck nail was statistically significant in the femoral head position ratio difference; the rest of the index P values are greater than 0.05, said The difference was not statistically significant.Logistic single factor analysis, fracture type, one week after operation TAD, after 1 weeks, the quality of reduction, a center of regional nail four indicators P value is less than 0.05, indicating statistically significant correlation between the four indexes and the loss of reduction; gender, age, after the medial femur the lesser trochanter bone displacement, Singh index, preoperative ASA score of 5 indicators of the P values are greater than 0.05, indicating the correlation between the five indexes and the loss of reduction is no statistically significant factor.Logistic regression analysis, TAD 1 weeks after operation, 1 weeks after operation, the quality of reduction, a center area has a nail significant impact on the loss of reduction (P0.05), OR=0.218 TAD 1 weeks after operation, TAD25mm is more likely to cause the loss of reduction, is caused by TAD25mm 4.6 times the loss of reduction; OR=5.508 1 weeks postoperative reduction quality, excellent quality is reset Protective factors of loss of reduction, illustrate the reduction quality as "poor" when the risk of loss of reduction is the reduction quality as "5.5 times". When a nail center region of OR=10.393, P=0.0000.01, have statistical significance, that is a piece of eccentric screw position, namely No. 1, No. 4 area is a protective factor for loss of reduction, resulting in loss of reduction of the risk of the nail is 10.4 times the eccentric position in the center of the area of nail; fracture type index P value is greater than 0.05, we believe that in multivariate analysis, no statistically significant effect on the loss of reduction. Conclusion: the quality of reduction was based on the Baumgaertner standard at least grade for the good, the posterior femoral medial cortical bone displacement within the 5mm can not force anatomical reduction, spiral blade tip apex distance TAD value within 25m, reasonable placement area in the BC District, located in the tip of spiral blade No. 1 and No. 4 area. For unstable fractures (Ic, Id) and severe osteoporosis, surgeons should be more strict in order to ensure the quality of surgery, and prevent osteoporosis after operation, so as to reduce the risk factor of postoperative reduction loss.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(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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