本文選題：轉(zhuǎn)子間骨折　切入點(diǎn)：髓外固定　出處：《天津醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:(1)回顧性分析手術(shù)治療股骨轉(zhuǎn)子間骨折的效果,明確髓內(nèi)、髓外固定的優(yōu)缺點(diǎn)及適應(yīng)癥。(2)通過隨機(jī)對照試驗對比分析不同長度髓內(nèi)釘治療股骨轉(zhuǎn)子間骨折時的臨床效果及并發(fā)癥。方法:(1)回顧性地分析了2011年1月至2014年10月份于我科就診并手術(shù)治療的轉(zhuǎn)子間骨折患者的住院資料。納入及排除標(biāo)準(zhǔn)如下:納入本研究的患者需具有完善的資料記錄;影像資料證實為轉(zhuǎn)子間骨折;股骨轉(zhuǎn)子間區(qū)域不存在轉(zhuǎn)移性癌癥等病理性改變。記錄患者的基本信息包括:年齡、性別、骨折側(cè)別及AO分型及骨密度值;記錄患者的手術(shù)相關(guān)信息:手術(shù)方式、手術(shù)持續(xù)時間、術(shù)前及術(shù)后24小時血紅蛋白及紅細(xì)胞壓積、輸血量、住院時間、并發(fā)癥等情況。(2)按照隨機(jī)數(shù)據(jù)表將參與試驗的患者隨機(jī)分配到長、短髓內(nèi)釘固定組。術(shù)前記錄患者的基本信息包括:年齡、性別、骨折側(cè)別及AO分型;AO分型由兩位主治醫(yī)師術(shù)前獨(dú)立依據(jù)患者的髖部正側(cè)位片進(jìn)行判斷。記錄患者的手術(shù)相關(guān)信息,包括手術(shù)持續(xù)時間、術(shù)前及術(shù)后24小時血紅蛋白及紅細(xì)胞壓積,記錄患者術(shù)中失血量及術(shù)后引流量,住院時間、并發(fā)癥等情況。結(jié)果:(1)回顧性分析了上述時間段之間在我科治療的轉(zhuǎn)子間骨折246例患者,排除不合格病例,最后共168例患者納入回顧性分析。男性62例,女性106例,平均年齡分別為(65±13.4,74±9.4歲)。發(fā)生在左側(cè)為88例,右側(cè)80例。其中71~80歲組的患者數(shù)最多,60~90歲的患者占據(jù)了總?cè)藬?shù)的絕大多數(shù),約81%。根據(jù)AO/OTA分型31-A1型患者數(shù)量為54例,31-A2型為100例,31-A3型為14例,各自比例分別為32.1%、59.5%及8.4%。髓外固定組(動力髖螺釘及經(jīng)皮加壓鋼板)患者男性22例,女性32例,平均年齡分別為(71±13.8,72±8.1)歲。全部為31-A1型患者,31-A1.1型10例,31-A1.2型36例,31-A1.3型8例。動力髖螺釘及經(jīng)皮加壓鋼板組患者術(shù)前一天平均HGB分別為(116.9±9.2,124.2±14.5)g/L,平均HCT為(35±3,36.5±3.7)%。手術(shù)時間為(81.1±17.4,86.1±17.6)min,未見明顯差異。術(shù)后24小時復(fù)查HGB分別為(101.6±6.1,114.2±13.7)g/L,平均HCT分別為(30.1±2.4,33.3±3.7)%,經(jīng)皮加壓鋼板固定組術(shù)后HGB及HCT高于動力髖螺釘固定組患者。兩組術(shù)后需要輸血的患者及總輸血量未見明顯差異。髓內(nèi)固定組(PFNA及Gamma 3釘)患者共114例,其中男性患者50例,女性64例,平均年齡分別為(65±12.7,75±10)歲。31-A1型32例,31-A2型68例,此外尚有少量31-A3型的患者,共14例。PFNA及Gamma 3釘組患者術(shù)前一天平均HGB分別為(116.4±17,120.6±15.4)g/L,平均HCT為(34.3±4.8,35.3±3.9)%。手術(shù)時間為(84.5±24.7,78.3±23.1)min,未見明顯差異。術(shù)后24小時復(fù)查HGB分別為(106.4±13.8,108.7±11.6)g/L,平均HCT分別為(32.1±3.6,31.3±3.1)%,上述各個指標(biāo)二者并無明顯統(tǒng)計學(xué)差異。髓外固定最常見的并發(fā)癥為術(shù)后切口感染,髓外固定術(shù)后的并發(fā)癥包括股骨再骨折、髖內(nèi)翻等。(2)隨機(jī)對照研究共納入2014年1月至2015年4月間56例老年股骨轉(zhuǎn)子間骨折患者,平均隨訪時間14.5(12-18)個月。長、短髓內(nèi)釘固定組患者各為28例,平均年齡分別為(72.4±6.7,72.7±6.4)歲,長髓內(nèi)釘固定組中,31-A1型患者數(shù)量為9例,31-A2型患者的數(shù)量為14例,A3型患者為5例。其中Gamma釘固定16例,PFNA固定12例。短髓內(nèi)釘固定組中,31-A1型患者數(shù)量為9例,31-A2型患者的數(shù)量為15例,3型患者為4例。其中Gamma釘固定11例,PFNA固定17例。長、短髓內(nèi)釘固定組患者術(shù)前一天HGB為(125.6±17.0,125.3±16.5)g/L,平均HCT為(34.2±4.7,35.1±4.3)%。平均手術(shù)時間為(61.5±11.8,45.3±9.2)min。C型臂透視次數(shù)平均為(30.2±9.9,32.5±9.3)次,總失血量為(627.2±217.1,507.0±134.6)m L,術(shù)后HGB為(96.5±10.2,102.1±11.8)g/L,平均HCT為(30.1±3.4,32.2±3.8)%。術(shù)后12月Harris功能評分為(84.8±5.6,84.2±5.6)。隨訪期間長髓內(nèi)釘出現(xiàn)6例內(nèi)固定相關(guān)并發(fā)癥:1例患者出現(xiàn)了髖內(nèi)翻,后期發(fā)生螺釘切出股骨頭;1例發(fā)生股骨近端外側(cè)壁劈裂;2例患者因再次摔倒出現(xiàn)假體尖端股骨骨折;1例患者出現(xiàn)髓內(nèi)釘斷裂情況。短釘固定出現(xiàn)5例內(nèi)固定相關(guān)并發(fā)癥,其中1例髖內(nèi)翻,未出現(xiàn)切出現(xiàn)象;2例術(shù)中出現(xiàn)股骨外側(cè)壁劈裂;1例假體尖端股骨骨折;1例患者出現(xiàn)近端骨折不愈合,主釘斷釘。結(jié)論:(1)嚴(yán)格選擇合適的病例進(jìn)行髓外固定,可以獲得良好的治療效果,無論動力髖螺釘或經(jīng)皮加壓鋼板均可有效治療穩(wěn)定型轉(zhuǎn)子間骨折,避免術(shù)后內(nèi)固定相關(guān)并發(fā)癥;(2)長、短髓內(nèi)釘治療股骨轉(zhuǎn)子間骨折時,短髓內(nèi)釘可以縮短手術(shù)時間,減少手術(shù)失血。二者在手術(shù)并發(fā)癥方面并無明顯區(qū)別。
[Abstract]:Objective: (1) retrospective analysis of surgical treatment of intertrochanteric fractures, intramedullary clear, the advantages and disadvantages of the extramedullary fixation and indications. (2) through the analysis of randomised controlled trials comparing the clinical effect and complications of the treatment of femoral intertrochanteric fracture with different length of intramedullary nail. Methods: (1) review based on the analysis of the data of hospitalized patients from January 2011 to 2014 October in our hospital and surgical treatment of intertrochanteric fractures. The inclusion and exclusion criteria are as follows: patients enrolled in the study with perfect records; image data confirmed the intertrochanteric fracture; femoral intertrochanteric region without metastatic cancer and other pathological changes to record the basic information of patients including age, gender, side and AO classification and bone mineral density of fractures; records of surgery related information of patients: surgery, duration of surgery, preoperative and postoperative 24 hours of hemoglobin and red blood cells Cell hematocrit, blood transfusion, hospitalization time, complications and so on. (2) according to the patients were randomly assigned to random data table will participate in the test to the long and short intramedullary nail fixation group. The preoperative records the basic information of patients including age, gender, side and AO type AO type of fracture; by two physicians independently according to patient's preoperative hip radiographs were recorded. The related information of patients, including the duration of surgery, preoperative and postoperative 24 hours of hemoglobin and hematocrit, blood loss in patients with volume and postoperative drainage, hospitalization time and complications. Results: (1) were retrospectively analyzed between the time when the rotor treated in our department between 246 cases of patients with fracture, eliminate unqualified cases, a total of 168 patients were enrolled in the retrospective analysis. 62 cases were male, 106 were female, the average age was (65 + 13.4,74 + 9.4) occurred in the left in 88. Cases, 鍙充晶80渚，

本文編號：1637936