本文選題：髓內(nèi)釘　切入點：鎖定鋼板　出處：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:比較股骨近端防旋轉(zhuǎn)髓內(nèi)釘(proximal femoral nail antirotation PFNA)和股骨近端解剖型鎖定鋼板(anatomic proximal femoral locking plate ALP)治療老年股骨轉(zhuǎn)子間骨折的療效。方法:回顧性搜集保定市骨科醫(yī)院及河北大學(xué)附屬醫(yī)院2011年1月至2014年1月期間通過PFNA和ALP兩種手術(shù)方式治療老年股骨轉(zhuǎn)子間骨折患者71例,其中得到完整隨訪病例42例,其中PFNA組22例(男:12例;女:10例);ALP組20例(男:12例;女:8例)。所有病例骨折類型按AO/OTA分型,其中PFNA組穩(wěn)定型10例,不穩(wěn)定型骨折12例;ALP組穩(wěn)定型10例,不穩(wěn)定型10例。詳細(xì)記錄兩組患者手術(shù)時間、手術(shù)切口長度、術(shù)中失血量、術(shù)后患肢負(fù)重時間、術(shù)后獨立行走時間、術(shù)后并發(fā)癥、住院時間、住院期間輸血量、骨折愈合時間,并且在術(shù)后1個月、3個月、6個月、12個月時對兩組患者進行日常生活活動(ADL)評分和Harris髖關(guān)節(jié)功能評分。最后應(yīng)用統(tǒng)計學(xué)軟件進行數(shù)據(jù)的處理,對兩種手術(shù)方式的效果進行比較。結(jié)果:本組71例患者,中間因各種原因失訪29例,最后42例獲得完整隨訪,隨訪時間12-36個月,平均24.5個月。所有數(shù)據(jù)應(yīng)用SPSS19.0軟件進行統(tǒng)計學(xué)分析:(1)術(shù)前及術(shù)中情況比較:兩組病例在年齡、性別、骨折類型及Singh指數(shù)方面比較無統(tǒng)計學(xué)差異(P0.05),兩組資料有可比性。兩組患者手術(shù)時間、切口長度、術(shù)中出血量比較有顯著性差異,均有統(tǒng)計學(xué)意義(P0.05);住院時間比較差異無統(tǒng)計學(xué)意義(P0.05)。(2)術(shù)后情況比較:兩組患者術(shù)后患肢負(fù)重時間、術(shù)后獨立行走時間、骨折愈合時間比較有統(tǒng)計學(xué)差異(P0.05);住院期間輸血量比較無統(tǒng)計學(xué)差異(P0.05)。(3)術(shù)后兩組患者髖關(guān)節(jié)功能情況(Harris評分)比較:受傷前兩組患者Harris評分比較無統(tǒng)計學(xué)差異(P0.05);術(shù)后1月、3月較受傷前差值比較有統(tǒng)計學(xué)差異(P0.05);術(shù)后6月、12個月較受傷前差值比較無統(tǒng)計學(xué)差異(P0.05);(4)術(shù)后兩組患者日常生活情況(ADL評分)比較:受傷前兩組患者ADL評分比較無統(tǒng)計學(xué)差異(P0.05);術(shù)后1月、3月較受傷前差值比較有統(tǒng)計學(xué)差異(P0.05);術(shù)后6月、12個月較受傷前差值比較無統(tǒng)計學(xué)差異(P0.05)。(5)術(shù)后髖關(guān)節(jié)Harris評分優(yōu)良率比較:兩組患者術(shù)后1個月、3個月Harris評分優(yōu)良率比較有統(tǒng)計學(xué)差異(P0.05)。術(shù)后6個月、12個月Harris評分優(yōu)良率比較無統(tǒng)計學(xué)差異(P0.05)。(6)術(shù)后并發(fā)癥比較:PFNA和ALP組髖內(nèi)翻和內(nèi)固定松動的發(fā)生率有統(tǒng)計學(xué)差異(P0.05),其他術(shù)后并發(fā)癥發(fā)生率比較無統(tǒng)計學(xué)差異(P0.05),兩組術(shù)后并發(fā)癥總發(fā)生率比較有統(tǒng)計學(xué)差異(P0.05)。結(jié)論:1 PFNA和ALP都是老年股骨轉(zhuǎn)子間骨折的有效治療方法,其在住院時間、住院期間輸血量及術(shù)后6月、12個月的Harris評分比較中并無顯著差異。2 PFNA與ALP比較,具有創(chuàng)傷小、手術(shù)時間短、術(shù)中出血少,且操作簡單、固定可靠,能使病人早期下地負(fù)重及功能鍛煉。3 PFNA治療股骨轉(zhuǎn)子間骨折短期療效好于ALP,ALP并發(fā)癥高于PFNA,但中長期療效無差別。
[Abstract]:Objective: to compare the effects of proximal femoral nail antirotation PFNA) and anatomic proximal femoral locking plate ALPNA) in the treatment of femoral intertrochanteric fractures in elderly patients. From January 2011 to January 2014, 71 elderly patients with intertrochanteric fracture of femur were treated by PFNA and ALP. Among them, 42 cases were followed up completely, including 22 cases in PFNA group (12 cases in male), 20 cases in group of 10 women in PFNA group (12 cases in male) and 8 cases in female group. All fracture types were classified according to AO/OTA classification, including 10 cases of stable type in PFNA group. There were 10 cases of stable type and 10 cases of unstable type in 12 cases of unstable fracture of ALP group. The operation time, the length of incision, the amount of blood lost during operation, the time of bearing weight of affected limb, the time of walking independently after operation, the postoperative complications were recorded in detail. Length of stay, amount of blood transfusion during hospitalization, time of fracture healing, At 1 month, 3 months, 6 months and 12 months after operation, the patients in the two groups were evaluated with ADL) and Harris hip function score. Finally, the data were processed by statistical software. Results: among the 71 patients, 29 cases were lost for various reasons, and 42 cases were followed up for 12-36 months. Mean 24.5 months. All data were statistically analyzed by SPSS19.0 software. (1) preoperative and intraoperative data were compared: age, sex, sex, There was no significant difference in fracture type and Singh index between the two groups (P 0.05). There were significant differences in operation time, incision length and intraoperative bleeding between the two groups. There was no significant difference in hospitalization time between the two groups (P 0.05, P 0.05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05). There was significant difference in fracture healing time (P 0.05); there was no significant difference in blood transfusion volume during hospitalization. (P 0.05) after operation, there was no significant difference in Harris score between the two groups (P 0.05). 1 month, 3 months after the injury compared with the pre-injury difference was statistically significant (P 0.05); 6 months after the operation, 12 months compared with the injury before the difference was not statistically significant (P0. 05 / 4) after the two groups of patients daily life and ADL scores) comparison: before the injury in the two groups of patients with ADL. There was no significant difference in score (P 0.05); there was significant difference in Harris score between 1 month and 3 months after operation compared with that before injury (P 0.05); in 6 months after operation, there was no significant difference in difference between 12 months and before injury (P 0.05); the excellent and good rate of hip joint Harris score in the two groups was higher than that in the control group. There was significant difference in the excellent and good rate of Harris score at 1 month and 3 months after operation. There was no significant difference in the excellent and good rate of Harris score at 6 months and 12 months after operation. There was significant difference in birth rate (P 0.05), but there was no significant difference in the incidence of other postoperative complications (P 0.05). There was a significant difference in the total incidence of postoperative complications between the two groups. Conclusion both PFNA and ALP are effective methods for the treatment of femoral intertrochanteric fractures in the elderly. There was no significant difference in the duration of hospitalization, the amount of blood transfusion during hospitalization and the Harris score of 6 months and 12 months after operation. There was no significant difference between the two groups. They had less trauma, shorter operative time, less intraoperative bleeding, simple operation and reliable fixation. The short term effect of 3. 3 PFNA in the treatment of femoral intertrochanteric fracture was better than that of ALP, but there was no difference in the medium and long term effect.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

【參考文獻】

相關(guān)期刊論文 前10條

1 宋肖舟;陳位;鄭杰;;倒置LISS鋼板結(jié)合鋼纜內(nèi)固定治療股骨粗隆下SeinsheimerⅤ型骨折[J];中國骨傷;2014年08期

2 章國躍;江和明;楊吉青;韓方磊;;PFNA微創(chuàng)治療82例高齡日常行動能力低股骨粗隆間骨折的初步療效分析[J];中醫(yī)臨床研究;2014年15期

3 宋曉東;吳學(xué)建;肖鵬;;PFNA Ⅱ治療老年股骨轉(zhuǎn)子間骨折的臨床研究[J];中國實用醫(yī)刊;2014年06期

4 侯國進;周方;張志山;姬洪全;田耘;;不同內(nèi)固定方式治療老年股骨粗隆間骨折圍手術(shù)期的失血特點分析[J];北京大學(xué)學(xué)報(醫(yī)學(xué)版);2013年05期

5 車偉偉;胡年宏;;股骨粗隆間骨折的治療現(xiàn)狀與進展[J];中國中醫(yī)骨傷科雜志;2013年07期

6 錢明權(quán);朱國興;陳剛;;動力髖螺釘聯(lián)合防旋阻擋釘與股骨近端髓內(nèi)釘治療不穩(wěn)定型股骨粗隆間骨折的對比研究[J];中國矯形外科雜志;2013年10期

7 弓志國;施德源;;PFNA治療高齡股骨粗隆間骨折臨床分析[J];中國骨與關(guān)節(jié)損傷雜志;2013年S1期

8 荊浩;周岳;南寵;伯宇;邱少東;胡寧敏;;DHS與倒置LISS治療股骨粗隆間骨折臨床療效比較[J];寧夏醫(yī)科大學(xué)學(xué)報;2013年04期

9 周明昊;呂建軍;謝威;江淮;黃軍;;鎖定鋼板和PFNA治療股骨粗隆間骨折的比較[J];安徽醫(yī)藥;2013年01期

10 李珩;彭昊;甘經(jīng)岳;;PFNA與解剖鎖定鋼板治療股骨轉(zhuǎn)子間骨折臨床療效分析[J];中國矯形外科雜志;2012年18期

，

本文編號：1653033