本文關鍵詞： 加長型PFNA 加長型第三代Gamma釘 股骨近端長段粉碎性骨折　出處：《廣西醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:比較加長型股骨近端防旋髓內(nèi)釘(long proximal femoral nail antirotation,long PFNA)與加長型第三代Gamma釘(prolonged third gener-ation of Gamma nail,pTGN)治療股骨近端長段粉碎性骨折(long commi-nuted fracture of proximal femoral)的臨床療效,為股骨近端長段粉碎性骨折患者內(nèi)固定的選擇提供參考依據(jù)。方法:回顧性研究廣西醫(yī)科大學第三附屬醫(yī)院骨科在2014年6月-2016年5月期間收治的股骨近端長段粉碎性骨折患者65例,采用long PFNA治療的有32例,采用pTGN治療的有33例。記錄兩組患者手術時間、術中出血量、術后尖頂距、住院時間、骨折愈合時間、術后并發(fā)癥、髖關節(jié)Harris評分等進行對比研究。并用SPSS20.0做數(shù)據(jù)整理及統(tǒng)計學分析。結果:long PFNA組和pTGN組在手術時間、術中出血量分別為122.15±17.65min和 132.58±20.50min、250.44士20.99ml和280.18士 16.58ml,兩組比較差異具有統(tǒng)計學意義(P0.05)。Singh指數(shù)≤3級的患者中,long PFNA組與pTGN組在術后6個月尖頂距分別為20.66±4.16mm和23.96± 3.56mm,兩組對比其差異具有統(tǒng)計學意義(P0.05)。long PFNA組和pTGN組在住院天數(shù)、術后并發(fā)癥、骨折愈合時間、術后6個月及術后12個月Harris評分對比,差異無統(tǒng)計學意義(P0.05)。結論:與pTGN相比,long PFNA治療骨質疏松的股骨近端長段粉碎性骨折患者,能充分發(fā)揮近端螺旋刀片打壓骨松質、抗旋轉、抗切割等優(yōu)勢,操作更為簡便,手術時間短,術中出血量少。而pTGN更適合于骨質較好的股骨近端長段粉碎性骨折青年患者,能充分發(fā)揮近端拉力螺釘?shù)募訅簝?yōu)勢。long PFNA與pTGN都是治療股骨近端長段粉碎性骨折可靠有效的內(nèi)固定物,都能使患者早期行功能鍛煉,促進髖關節(jié)功能恢復,術后并發(fā)癥少,住院時間短,促進骨折愈合。根據(jù)患者的具體情況,合理選擇內(nèi)固定物是股骨近端長段粉碎性骨折手術成功的關鍵。
[Abstract]:Objective: to compare the clinical effects of long proximal femoral nail antirotation long PFNAs and extended third generation Gamma nailing third gener-ation of Gamma nailpTGNs in the treatment of long commi-nuted fracture of proximal femur fractures. Methods: a retrospective study of the proximal long femoral long segment powder treated in the Department of Orthopaedics of the third affiliated Hospital of Guangxi Medical University from June 2014 to May 2016 was conducted to provide a reference for the selection of internal fixation for the patients with proximal long femoral comminuted fractures. 65 patients with broken fractures, 32 cases were treated with long PFNA, 33 cases were treated with pTGN. The Harris score of hip joint was compared and analyzed with SPSS20.0. Results the operation time of PFNA group and pTGN group was compared with that of pTGN group. The intraoperative bleeding volumes were 122.15 鹵17.65min and 132.58 鹵20.50min, 250.44 鹵20.99ml and 280.18 鹵16.58ml, respectively. There was a statistically significant difference between the two groups in the peak distance between the two groups at 6 months after the operation. The difference between the two groups was 20.66 鹵4.16mm and 23.96 鹵3.56mm, respectively. The difference was statistically significant (P 0.05). Long PFNA group and pTGN group were in hospital days. There was no significant difference in postoperative complications, fracture healing time, Harris score between 6 months and 12 months after operation (P 0.05). Conclusion: compared with pTGN, long PFNA is used to treat patients with long proximal comminuted fracture of femur. It can give full play to the advantages of proximal helical blade, such as pressing cancellous bone, anti-rotation, anti-cutting, etc., the operation is simpler, the operation time is short, and the amount of intraoperative bleeding is less. However, pTGN is more suitable for young patients with long proximal comminuted fracture of femur. Long PFNA and pTGN are reliable and effective internal fixators in the treatment of proximal long segment comminuted fractures. Both of them can make the patients perform early functional exercise and promote the recovery of hip joint function. According to the specific conditions of the patients, reasonable selection of internal fixator is the key to successful operation of proximal long segment comminuted fracture of femur.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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