發(fā)布時(shí)間：2018-02-24 21:04

  本文關(guān)鍵詞： 股骨近端防旋髓內(nèi)釘 人工股骨頭置換 老年骨質(zhì)疏松 股骨粗隆間骨折　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過對(duì)比研究PFNA和人工股骨頭置換兩種術(shù)式治療老年骨質(zhì)疏松性股骨粗隆間骨折的臨床療效,進(jìn)而探討針對(duì)老年性骨質(zhì)疏松股骨粗隆間骨折患者的有效的治療方法。方法:從2006年6月到2014年6月,榮成市人民醫(yī)院骨外科共收治股骨粗隆間骨折患者240例,其中老年骨質(zhì)疏松性股骨粗隆間骨折患者158例。老年骨質(zhì)疏松性股骨粗隆間骨折患者中,男性66例,女性92例,年齡65歲-95歲,平均年齡74.2歲,所有患者通過X線片或者骨密度檢查均可見明顯骨質(zhì)疏松表現(xiàn),按照Singh指數(shù),IV度以下均定性為骨質(zhì)疏松癥。分別采用股骨近端防旋髓內(nèi)釘(PFNA組)和人工股骨頭置換(AFHR組)兩種方法對(duì)老年性骨質(zhì)疏松性股骨粗隆間骨折患者行手術(shù)治療。其中,PFNA組83例,男性32例,女性51例,年齡(75.36±4.86)歲;AFHR組75例,男性30例,女性45例,年齡(75.19±5.37)歲。分別從年齡、性別、受傷側(cè)、骨折AO分型、受傷機(jī)制、ASA分級(jí)、受傷前的活動(dòng)能力、隨訪時(shí)間等術(shù)前基本信息,切口長(zhǎng)度、手術(shù)時(shí)間、術(shù)中出血量、透視時(shí)間、術(shù)后引流、住院日期、術(shù)后負(fù)重時(shí)間等術(shù)中、術(shù)后相關(guān)指標(biāo),刀口感染、褥瘡、DVT、肺部感染、泌尿系感染、死亡等早期并發(fā)癥,Harris評(píng)分等多項(xiàng)指標(biāo)對(duì)比分析研究?jī)煞N不同治療方法的療效。研究結(jié)果:從年齡、性別、受傷側(cè)、骨折AO分型、受傷機(jī)制、ASA分級(jí)、受傷前的活動(dòng)能力、隨訪時(shí)間等術(shù)前基本信息評(píng)估PFNA與人工半髖置換兩種手術(shù)治療方法,二者無(wú)統(tǒng)計(jì)學(xué)意義的差別,證明兩組不同治療方案數(shù)據(jù)具有可比性。在切口長(zhǎng)度、手術(shù)時(shí)間、術(shù)中出血、術(shù)后引流等手術(shù)創(chuàng)傷指標(biāo)評(píng)估兩種治療方案,PFNA組要優(yōu)于人工股骨頭置換組,二者具有統(tǒng)計(jì)學(xué)意義;在術(shù)中透視時(shí)間、住院時(shí)間方面,人工骨頭置換組短于PFNA組,二者具有統(tǒng)計(jì)學(xué)意義;然而,在術(shù)后負(fù)重時(shí)間方面,人工股骨頭置換組短于PFNA組,二者具有統(tǒng)計(jì)學(xué)意義。在刀口感染、褥瘡、DVT、肺部感染、泌尿系感染、死亡等早期并發(fā)癥方面,人工股骨頭置換組明顯優(yōu)于PFNA組,二者具有統(tǒng)計(jì)學(xué)意義。術(shù)后一年髖關(guān)節(jié)評(píng)分-Harris評(píng)分對(duì)比,PFNA組與人工股骨頭置換組二者無(wú)明顯區(qū)別,不具有統(tǒng)計(jì)學(xué)意義。結(jié)論:人工股骨頭置換術(shù)能夠讓患者術(shù)后早期下地活動(dòng),縮短住院時(shí)間,減少早期臥床并發(fā)癥,獲得滿意的功能,是治療老年骨質(zhì)疏松性轉(zhuǎn)子間骨折的有效方法。
[Abstract]:Objective: to compare the clinical effect of PFNA and artificial femoral head replacement in the treatment of osteoporotic intertrochanteric fracture of femur. Methods: from June 2006 to June 2014, 240 patients with intertrochanteric fracture of femur were treated in Rongcheng people's Hospital. There were 158 cases of osteoporotic intertrochanteric fracture of femur, 66 cases of male and 92 cases of female, aged from 65 to 95 years old, with an average age of 74.2 years. All the patients showed obvious osteoporosis by X-ray or bone mineral density examination. According to the Singh index below grade IV, osteoporosis was characterized as osteoporosis. The patients with senile osteoporotic femoral intertrochanteric fracture were treated with two methods: proximal femoral intramedullary nail (PFNA group) and artificial femoral head replacement (Singh group). Surgical treatment was performed in 83 cases of PFNA group. There were 32 males, 51 females, 75 patients in AFHR group (75.36 鹵4.86) years old, 30 males and 45 females, aged 75.19 鹵5.37 years. Preoperative basic information, incision length, operative time, intraoperative bleeding volume, fluoroscopy time, postoperative drainage, hospitalization date, postoperative weight-bearing time, postoperative index, wound infection, bedsore DVT, pulmonary infection, etc. The efficacy of two different treatment methods was compared with Harris score of early complications such as urinary tract infection and death. Results: according to age, sex, injured side, AO classification of fracture, injury mechanism, ASA grade, and so on, the patients were divided into two groups: the age, the sex, the injured side, the AO type of fracture, the mechanism of injury, and so on. The basic information of preoperative activity before injury and follow-up time were used to evaluate PFNA and prosthetic hemiarthroplasty. There was no significant difference between the two groups, which proved that the data of different treatment schemes were comparable. Evaluation of surgical trauma indexes such as operative time, intraoperative bleeding, postoperative drainage and so on, the PFNA group was superior to the artificial femoral head replacement group in terms of the time of fluoroscopy and the length of hospitalization. The artificial bone replacement group was shorter than the PFNA group, which had statistical significance, however, the artificial femoral head replacement group was shorter than the PFNA group in weight bearing time after operation. In terms of early complications such as urinary tract infection and death, the artificial femoral head replacement group was significantly better than the PFNA group, which had statistical significance. The hip joint score-Harris score was not significantly different between the PFNA group and the artificial femoral head replacement group one year after operation. Conclusion: artificial femoral head replacement can make the patients go down early after operation, shorten the hospitalization time, reduce the complications of early bed rest, and obtain satisfactory function. It is an effective method to treat senile osteoporotic intertrochanteric fracture.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

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