本文選題：動力髖螺釘(DHS)　切入點：股骨近端抗旋髓內(nèi)釘(PFNA)　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:回顧性分析股骨近端防旋髓內(nèi)釘(proximalfemoralnail Anti-rotation PFNA)、動力髖螺釘(DHS)及人工關(guān)節(jié)置換在治療老年股骨粗隆間骨折的臨床療效。以便為臨床提供參考,更好的對手術(shù)方式進行選擇。方法:隨機抽取我院骨科2012年6月至2016年6月收治的共140例老年股骨粗隆間骨折的治療病例。年齡63歲至91歲,平均年齡75.1歲,其中男49例,女91例。分別采用DHS、人工股骨頭置換、PFNA治療,比較PFNA、DHS和人工關(guān)節(jié)置換術(shù)這三種治療方法的手術(shù)切口長度、手術(shù)時間、術(shù)中出血量、圍手術(shù)期輸血量、術(shù)后開始負重時間及術(shù)后1年的患髖關(guān)節(jié)評分(Harris評分)等指標,SPSS17.0軟件被用來處理相關(guān)的數(shù)據(jù),得出統(tǒng)計學(xué)處理結(jié)果。結(jié)果:按照隨機數(shù)字表法隨機隨訪140例老年股骨粗隆間骨折的患者,隨訪時間7~25個月,平均13.8±1.3個月。DHS組(46):切口長度10~16cm;手術(shù)時間110.4±25.4min;術(shù)中出血351±51.2ml;圍手術(shù)期輸血量131.5±51.2ml;術(shù)后負重時間42~94天;術(shù)后1年髖關(guān)節(jié)Harris評分:優(yōu)32例,良10例,可2例,差2例,優(yōu)良率91.3%。PFNA組(49):切口長度5~7cm;手術(shù)時間52.1±15.5min;術(shù)中出血211±31.4ml;圍手術(shù)期輸血量91.2±31.7ml;術(shù)后負重時間3~10天;術(shù)后1年髖關(guān)節(jié)Harris評分:優(yōu)33例,良13例,可2例,差1例,優(yōu)良率93.8%。人工關(guān)節(jié)置換組(45):切口長度12~18cm;手術(shù)時間89.2±18.9min;術(shù)中出血410±81.4ml;術(shù)后負重時間4~12天;圍手術(shù)期輸血量400.2±35.9ml術(shù)后1年髖關(guān)節(jié)Harris評分:優(yōu)30,良12例,可2例,差1例,優(yōu)良率93.3%。將以上數(shù)據(jù)進行比較及統(tǒng)計學(xué)分析提示:三組在切口長度及手術(shù)時間上PFNA組相對于人工股骨頭置組及DHS組具有明顯優(yōu)勢,差異均有統(tǒng)計學(xué)意義(P0.05)。術(shù)中出血不符合正態(tài)分布且方差不齊,因此采用非參數(shù)秩和檢驗,P0.05因此認為三者之間有顯著性差異,兩兩比較后,PFNA組的出血量最少,而人工關(guān)節(jié)組的出血量最多。輸血量不符合正態(tài)分布且方差不齊,采用非參數(shù)秩和檢驗,P0.05因此三者之間有顯著性差異,兩兩比較,人工關(guān)節(jié)組較其他兩組輸血量多,DHS組與PFNA組之間輸血量無明顯差異。術(shù)后開始負重時間不符合正態(tài)分布且方差不齊,采用非參數(shù)秩和檢驗,P0.05因此三者之間有顯著性差異,兩兩比較,DHS組較其他兩組術(shù)后開始負重時間長,PFNA組與人工關(guān)節(jié)組無明顯差異。結(jié)論:三種手法方式對于治療老年股骨粗隆間骨折均能取得良好療效。PFNA組較DHS組與人工股骨頭置換組,手術(shù)切口長度、手術(shù)持續(xù)時間、術(shù)中出血量、圍手術(shù)期輸血量及術(shù)后開始負重時間等指標方面均占優(yōu)勢。因此PFNA是治療老年股骨粗隆間骨折的理想選擇。
[Abstract]:Objective: to retrospectively analyze the clinical effect of proximal femoral nail Anti-rotation (dynamic hip screw) and artificial joint replacement in the treatment of femoral intertrochanteric fracture in elderly patients. Methods: 140 cases of femoral intertrochanteric fracture were randomly selected from our orthopedic department from June 2012 to June 2016. The patients ranged from 63 to 91 years old with an average age of 75.1 years (49 males). 91 female patients were treated with DHSand artificial femoral head replacement PFNA respectively. The incision length, operative time, intraoperative blood loss and perioperative blood transfusion were compared between PFNAN DHS and artificial joint replacement. SPSS 17.0 software was used to process the relevant data. Results: 140 elderly patients with intertrochanteric fracture of femur were followed up by random digital table for 7 ~ 25 months. Mean 13.8 鹵1.3 months. DHS group: incision length 1016 cm; operative time 110.4 鹵25.4 min; intraoperative bleeding 351 鹵51.2 ml; perioperative transfusion volume 131.5 鹵51.2 ml; postoperative weight loading time 421,94 days; hip joint Harris score: excellent 32 cases, good 10 cases, fair 2 cases, poor 2 cases, 1 year after operation, the hip joint Harris score was excellent in 32 cases, good in 10 cases, fair in 2 cases, and poor in 2 cases. The excellent and good rate of 91.3%.PFNA group was as follows: incision length 52.5 cm; operative time 52.1 鹵15.5min; intraoperative bleeding 211 鹵31.4 ml; perioperative transfusion 91.2 鹵31.7 ml; postoperative weight loading time 310 days; hip joint Harris score: excellent 33 cases, good 13 cases, fair 2 cases, poor 1 case. The excellent and good rate was 93.8.The Harris score of hip joint in the artificial joint replacement group was excellent 30, good in 12 cases, fair in 2 cases, fair in 2 cases, poor in 1 case, operative time was 89.2 鹵18.9 min, intraoperative bleeding 410 鹵81.4 ml, weight bearing time 412 days, perioperative transfusion volume 400.2 鹵35.9ml 1 year after operation: excellent, good in 12 cases, fair in 2 cases, poor in 1 case, good in 12 cases, good in 12 cases, fair in 2 cases, and poor in 1 case. The excellent and good rate was 93.3.Compared with the above data and statistical analysis, it was concluded that the PFNA group had obvious advantages over the artificial femoral head placement group and the DHS group in incision length and operation time. The difference was statistically significant (P 0.05). The intraoperative bleeding did not accord with normal distribution and the variance was not uniform. Therefore, the nonparametric rank sum test (P0.05) was used to conclude that there was a significant difference among the three groups, and the amount of bleeding in PFNA group was the least after pairwise comparison. The amount of blood loss in artificial joint group was the most. The amount of blood transfusion did not accord with normal distribution and the variance was not uniform. Therefore, there was significant difference among the three groups by using non-parametric rank sum test (P0.05). There was no significant difference between the artificial joint group and the other two groups in the amount of blood transfusion between the DHS group and the PFNA group. The weight loading time did not accord with the normal distribution and the variance was not uniform. The nonparametric rank sum test was used to test P05 so there was significant difference among the three groups. Compared with the other two groups, there was no significant difference between the two groups. Conclusion: the treatment of intertrochanteric fracture of the femur with three manipulations can achieve good curative effect. PFNA group is more effective than DHS group in the treatment of intertrochanteric fracture of femur. PNA group is better than DHS group in the treatment of intertrochanteric fracture of femur. Artificial femoral head replacement group, The operative incision length, operative duration, intraoperative blood loss, perioperative blood transfusion and postoperative weight bearing time were all dominant. Therefore, PFNA is an ideal choice for the treatment of senile intertrochanteric fracture.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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