發(fā)布時(shí)間：2018-03-26 02:16

  本文選題：股骨粗隆間骨折　切入點(diǎn)：股骨矩　出處：《大連醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:記錄股骨近端抗旋髓內(nèi)釘(PFNA)治療股骨轉(zhuǎn)子間骨折(IFF)患者的術(shù)后和術(shù)后6個(gè)月的X線影像學(xué)信息,通過術(shù)后及術(shù)后半年TAD值的變化程度,反應(yīng)術(shù)中股骨矩的復(fù)位對(duì)股骨粗隆間骨折PFNA中螺旋刀片的影響,同時(shí)為骨外科醫(yī)師提供參考數(shù)據(jù)及更深一步的研究。方法:回顧性的統(tǒng)計(jì)2012年至2014年大連醫(yī)科大學(xué)附屬二院住院并接股骨近端抗螺旋髓內(nèi)釘手術(shù)治療的患者64例,其中8例因不滿足預(yù)設(shè)樣本標(biāo)準(zhǔn),予以剔除,余56例患者(61歲-89歲)均得到6-10個(gè)月的隨訪,查閱大連醫(yī)科大學(xué)附屬二院的住院記錄收集相應(yīng)的術(shù)中、術(shù)后及術(shù)后半年的骨折端復(fù)位情況、愈合情況、螺旋刀片的位置及頂尖距值(tip-apex distance,TAD)。將56例患者按照Baumgaetner法評(píng)估股骨距[1]的復(fù)位情況分成A(優(yōu)良組)、B(差組)兩組(評(píng)估股骨矩的方法包括頸干角在正位X線片上正常或輕度外翻,側(cè)位片上形成角小于20°的角度,水平位移在正、側(cè)位X線片上均小于4mm可被評(píng)定為定義為復(fù)位良好,反之評(píng)定為差),測(cè)量56例患者術(shù)后當(dāng)時(shí)和術(shù)后半年的的TAD值,統(tǒng)計(jì)出兩組各時(shí)期的TAD均值及均值差值,根據(jù)統(tǒng)計(jì)結(jié)果觀察股骨矩的復(fù)位對(duì)螺旋刀片的位移有無影響。結(jié)果:56例行PFNA內(nèi)固定術(shù)患者均獲得6-10月隨訪。利用Harris髖關(guān)節(jié)評(píng)分標(biāo)準(zhǔn)測(cè)隨訪56例患者,結(jié)果顯示髖關(guān)節(jié)功能評(píng)分優(yōu)良率90.8%。本研究術(shù)后隨訪共出現(xiàn)9例力學(xué)并發(fā)癥患者。A組1例,B組8例;A組1例螺旋刀片出現(xiàn)有向關(guān)節(jié)面穿出趨勢(shì),離關(guān)節(jié)面約3mm,半年內(nèi)X線正位片移位約8mm;B組3例出現(xiàn)螺旋刀片明顯切出趨勢(shì),正位X線片見向外上方移位,位移分別為5mm、8mm、9mm,2例出現(xiàn)螺旋刀片向外側(cè)橫行移位大于10mm;2例螺旋刀片有向股骨頭方向穿出趨勢(shì),分別距髖關(guān)節(jié)面約3mm、4mm,半年內(nèi)X線正位片移位分別為9mm、7mm;1例術(shù)后10個(gè)月出現(xiàn)主釘斷裂現(xiàn)象,其術(shù)后TAD值為32mm。余45例患者骨折完全愈合,皆無切出、退釘、斷釘?shù)鹊膰?yán)重并發(fā)癥發(fā)生,患者髖關(guān)節(jié)功能恢復(fù)良好。結(jié)論:通過數(shù)據(jù)整理、歸納、統(tǒng)計(jì)及分析可以初步的推斷出股骨矩復(fù)位的優(yōu)良程度對(duì)螺旋刀片的切出率有著明顯的影響。當(dāng)股骨矩復(fù)位滿意時(shí),術(shù)后及術(shù)后半年的TAD差值均值為5.33mm,無螺旋刀片切出、斷釘?shù)葒?yán)重并發(fā)癥出現(xiàn);當(dāng)股骨矩復(fù)位未達(dá)到標(biāo)準(zhǔn)時(shí),TAD差值均值顯著增大,螺旋刀片半年內(nèi)移位明顯,平均為8.78mm,螺旋刀片發(fā)生切出趨勢(shì)明顯增加。
[Abstract]:Objective: to record the radiographic information of patients with intertrochanteric fracture of femur treated by proximal femur anti-rotation intramedullary nail (PFNA), and to record the degree of change of TAD value after operation and half a year after operation, and to record the radiographic information of patients with intratrochanteric fracture of femur. Effect of reduction of femoral moment during reaction on spiral blade in PFNA of intertrochanteric fracture of femur. Methods: from 2012 to 2014, 64 patients admitted to the second affiliated Hospital of Dalian Medical University and treated with proximal femoral anti-spiral intramedullary nail were analyzed retrospectively. Among them, 8 patients were excluded because they did not meet the preset sample criteria. The remaining 56 patients aged 61 to 89 were followed up for 6 to 10 months. The hospital records of the second affiliated Hospital of Dalian Medical University were collected during the operation. After operation and half a year after the fracture end reduction, healing situation, The position and tip distance of the helical blade were evaluated by Baumgaetner method. 56 patients were divided into two groups: group A (excellent group) and group B (poor group). The method of evaluating femoral moment included normal or slight vertication of neck shaft angle on orthostatic radiographs. The angle formed on the lateral film was less than 20 擄, and the horizontal displacement was less than 20 擄. The horizontal displacement was less than 20 擄on the lateral X-ray film and the horizontal displacement was less than 20 擄on the lateral X-ray film. The TAD values of 56 patients were measured at the time of operation and half a year after operation. The mean and difference of TAD in each period of the two groups were calculated. According to the statistical results, the effect of femoral moment reduction on the displacement of helical blades was observed. Results all 56 cases of PFNA internal fixation were followed up for 6-10 months. 56 cases were followed up with Harris hip score standard. The results showed that the excellent and good rate of hip joint function score was 90.8%. In this study, 9 cases of mechanical complications occurred in group A, 1 case in group A, 8 cases in group A, 1 case in group A, and 1 case in group A had a tendency to perforate the articular surface. It was about 3 mm away from the articular surface. In group B, the positive radiographs were displaced about 8 mm within half a year. In group B, the spiral blade was cut out obviously, and the positive X ray film showed outward and superior displacement. The displacement was 5mm / 8mm / 9mm respectively in 2 cases, the lateral displacement of the helical blade was greater than 10mm and 2 cases had the tendency of perforating towards the femoral head. Within half a year, the displacement of X ray positive film was 9mm / 7mm respectively. The main nail fracture occurred in 1 case 10 months after operation. The postoperative TAD value was 32mm. the remaining 45 cases were completely healed without serious complications, such as excision, denailing, nail disconnection, and so on. Conclusion: through data arrangement, induction, statistics and analysis, it can be preliminarily inferred that the excellent degree of femoral moment reduction has a significant effect on the cutting rate of the helical blade. The mean value of TAD difference was 5.33 mm after operation and half a year after operation, no serious complications such as cutting out of screw blade and broken nail appeared, the mean value of difference of TAD increased significantly when the reduction of femur moment was not up to the standard, and the displacement of screw blade was obvious within half a year. The average is 8.78 mm, the cutting out trend of the screw blade increases obviously.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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