發(fā)布時(shí)間：2018-04-14 03:26

  本文選題：髖骨折 + 骨折固定術(shù)�。� 參考：《蘇州大學(xué)》2015年碩士論文

【摘要】：目的探討沿股骨頸上緣所作切線能否用來(lái)評(píng)估髓內(nèi)釘治療股骨粗隆間骨折所致外側(cè)壁破裂的風(fēng)險(xiǎn),并比較Intertan和Gamma3兩種不同髓內(nèi)釘對(duì)外側(cè)壁影響的差異。方法回顧性分析2014年8月至2015年2月連續(xù)收治采用Intertan髓內(nèi)釘或Gamma3釘治療的56例的股骨粗隆間骨折患者影像學(xué)資料(其中有6例骨折線由股骨外側(cè)肌嵴以下穿出),所有患者術(shù)前、術(shù)后均行X線和三維CT掃描。將50例骨折線由外側(cè)肌嵴以上穿出患者資料按術(shù)中有無(wú)引起外側(cè)壁破裂和髓內(nèi)固定物不同分別進(jìn)行分組。根據(jù)術(shù)中有無(wú)引起外側(cè)壁破裂分成兩組:外側(cè)壁破裂組17例,平均年齡77歲(54-92);OTA31-A1型3例,OTA31-A2型14例。外側(cè)壁未破裂組33例,平均年齡74歲(47-94);OTA31-A1型17例,OTA31-A2型16例。測(cè)量、記錄并比較兩組患者的骨折線穿出點(diǎn)至外側(cè)肌嵴的長(zhǎng)度、尖頂距。再應(yīng)用ROC曲線求得區(qū)分外側(cè)壁破裂與否的骨折線至外側(cè)肌嵴長(zhǎng)度的最佳臨界值。還從這50例患者中按其男女比例分層抽得25例,測(cè)量、記錄這25例患者對(duì)側(cè)未骨折骨股骨頸上緣切線穿出點(diǎn)至股骨外側(cè)肌嵴的長(zhǎng)度,并與最佳臨界值相比較。此外,還比較了Intertan和Gamma3兩種不同髓內(nèi)釘所致外側(cè)壁破裂發(fā)生率的大小。結(jié)果術(shù)中外側(cè)壁破裂組和未破裂組,骨折線穿出點(diǎn)至外側(cè)肌嵴長(zhǎng)度的平均值分別為(15.6±6.33)mm、(28.5±6.76)mm,差異有統(tǒng)計(jì)學(xué)意義(P=0.00000004);術(shù)中外側(cè)壁破裂的發(fā)生率,OTA31-A2型骨折為46.7%(14/30)高于OTA31-A1型骨折的15%(3/20)(P=0.021);尖頂距平均值分別為(16.8±3.76)mm、(20.2±6.76)mm,差異亦有統(tǒng)計(jì)學(xué)意義(P=0.024);應(yīng)用ROC曲線求得的骨折線穿出點(diǎn)至股骨外側(cè)肌嵴長(zhǎng)度的最佳臨界值為20.445mm(靈敏度90.9%,特異度88.2%);25例對(duì)側(cè)未骨折骨股骨頸上緣切線穿出點(diǎn)至股骨外側(cè)肌嵴長(zhǎng)度的平均值為(19.4±3.16)mm,與臨界值20.445mm相近,兩者間差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.109)。此外,Intertan髓內(nèi)釘治療組術(shù)中外側(cè)壁的發(fā)生率為38.7%(12/31),Gamma3釘治療組為26.3%(5/19),可經(jīng)統(tǒng)計(jì)學(xué)分析,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.369)。結(jié)論骨折線穿出點(diǎn)至股骨外側(cè)肌嵴的長(zhǎng)度可以用來(lái)評(píng)估髓內(nèi)釘治療股骨粗隆間骨折所致的外側(cè)壁破裂風(fēng)險(xiǎn),當(dāng)該長(zhǎng)度小于20.445mm時(shí),術(shù)中易發(fā)生外側(cè)壁破裂。臨界值20.445mm所對(duì)應(yīng)的位置可能就是沿股骨頸上緣所作切線穿出點(diǎn)處。Intertan與Gamma3兩種不同髓內(nèi)釘所致外側(cè)壁破裂的發(fā)生不存在明顯差異。
[Abstract]:Objective to evaluate the risk of lateral wall rupture caused by intramedullary nail in the treatment of intertrochanteric femoral fractures, and to compare the effects of Intertan and Gamma3 on the lateral wall of femoral intertrochanteric nail.Methods from August 2014 to February 2015, 56 patients with intertrochanteric fracture of femur treated with Intertan intramedullary nail or Gamma3 nail were retrospectively analyzed.X-ray and three-dimensional CT scans were performed after operation.The data of 50 patients with fracture line perforating from lateral muscle crest were divided into two groups according to whether there were rupture of lateral wall and intramedullary fixation.According to whether or not the lateral wall rupture was caused during the operation, 17 cases were divided into two groups: 17 cases in the lateral wall rupture group, with an average age of 77 years old and 3 cases with OTA31-A1 type OTA31-A2 type.There were 33 cases in the lateral wall unruptured group, with an average age of 74 years old, 17 cases of OTA31-A1 type OTA31-A1 type and 16 cases of OTA31-A2 type.To measure, record and compare the length of the fracture line from the point of entry to the lateral muscle crest and the apical distance between the two groups.Then the ROC curve was used to obtain the best critical value from the fracture line to the length of lateral muscle crest to distinguish whether the lateral wall was ruptured or not.25 of the 50 patients were stratified according to their ratio of male to female. The length of the superior margin tangential line of the contralateral unfractured femoral neck to the lateral femoral muscle crest was recorded and compared with the optimal critical value.In addition, the incidence of lateral wall rupture caused by two different intramedullary nails (Intertan and Gamma3) was compared.Results the lateral wall rupture group and the unruptured group,The average length of the muscle crest from the perforating point of fracture line to the lateral muscle crest was 15.6 鹵6.33mm and 28.5 鹵6.76mm. the difference was statistically significant, and the incidence of rupture of lateral wall was 46.7% 1430% (P < 0.05), which was higher than that of OTA31-A1 fracture (1533 / 20), and the mean apical distance was 16.8 鹵3.76mm (20.2 鹵6.76mm), respectively.The best critical value from the point of fracture line to the length of the lateral femur muscle crest obtained by ROC curve is 20.445mm (sensitivity 90.9mm, specificity 88.2mm).The mean value is 19.4 鹵3.16mm, which is close to the critical value 20.445mm.There was no significant difference between the two groups.In addition, the incidence of intraoperative lateral wall in the Intertan intramedullary nailing group was 38.7 / 31g / 31.The incidence of the intraoperative lateral wall in the Gamma3 nail group was 26.310 / 19. The difference was not statistically significant (P < 0.05).Conclusion the length from the point of the fracture line to the lateral femoral crest can be used to evaluate the risk of lateral wall rupture caused by intramedullary nail in the treatment of intertrochanteric fracture. When the length is less than 20.445mm, the lateral wall rupture is easy to occur during the operation.The location corresponding to the critical value of 20.445mm may be that there is no significant difference in the occurrence of lateral wall rupture caused by two kinds of intramedullary nails, I. e. Intertan and Gamma3, along the superior margin of femoral neck.
【學(xué)位授予單位】：蘇州大學(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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