本文選題：全髖關(guān)節(jié)置換術(shù) + 股骨近端髓腔形態(tài)��； 參考：《山東中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:觀察實(shí)施全髖關(guān)節(jié)置換術(shù)治療患者的股骨近段髓腔形態(tài)和假體周圍骨折發(fā)生情況之間的相關(guān)性,統(tǒng)計(jì)總結(jié)在實(shí)施全髖關(guān)節(jié)置換術(shù)中、術(shù)后出現(xiàn)假體周圍骨折的發(fā)病因素、發(fā)病機(jī)制以及骨折類型。以期通過患者近端髓腔形態(tài)預(yù)判假體周圍骨折的可能性,指導(dǎo)人工全髖關(guān)節(jié)置換術(shù)中假體的選擇最終提升全髖關(guān)節(jié)置換的治療效果以及治療安全性。方法:收集我校各臨床學(xué)院自2010年6月到2016年5月6年內(nèi)行人工全髖關(guān)節(jié)置換術(shù)的患者的病例,選取成功回訪,并且資料齊全的患者,利用隨機(jī)分配原則,選取500例,利用X線影像學(xué)圖片,收集并統(tǒng)計(jì)術(shù)中假體類型的選擇、髓腔形態(tài),統(tǒng)計(jì)術(shù)中、術(shù)后假體周圍骨折的發(fā)生情況,并利用統(tǒng)計(jì)學(xué)軟件對(duì)相關(guān)因素進(jìn)行分析,從而分析股骨近端髓腔形態(tài)不同的患者的術(shù)中、術(shù)后假體周圍骨折發(fā)病率。結(jié)果:1.患者總量為500例,男女分別為340例和160例,年齡在41-86歲,平均69.85±8.74歲。所有患者的影像學(xué)檢查顯示,正常髓腔患者占比80%(400例),煙囪型患者占比11%(55例),倒香檳型患者占比9%(45例)。男性患者中正常髓腔占比80.88%(275例),倒香檳型占比8.82%(30例),煙囪型占比10.29%(35例)。女性患者中正常髓腔占比78.12%(125例),倒香檳型占比9.37%(15例),煙囪型占比12.5%(20例)。2.在本次研究中,假體周圍骨折的發(fā)生率為4%,包括10例女性和10例男性患者。男性患者平均年齡為75.36±3.51歲,女性患者平均年齡為70.23±5.42歲。在這20例患者中,倒香檳型8例(男3、女5),煙囪型8例(男5、女3),正常型4例(男2、女2)。各型的假體周圍骨折發(fā)病率分別為:正常型1%,煙囪型14.55%,倒香檳型17.78%。通過統(tǒng)計(jì)學(xué)分析,女性患者發(fā)病率明顯高于男性,煙囪型及倒香檳型患者的發(fā)病率明顯高于正常型患者,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:在對(duì)患者實(shí)施全髖關(guān)節(jié)置換術(shù)治療時(shí),女性患者的假體周圍骨折發(fā)生率明顯高于男性患者;而在股骨近端髓腔形態(tài)方面,倒香檳型和倒煙囪型髓腔形態(tài)患者在假體周圍骨折發(fā)生率方面明顯高于正常髓腔型患者;老年患者假體周圍骨折的發(fā)生率明顯高于年輕患者。因此在臨床實(shí)施全髖關(guān)節(jié)置換術(shù)治療時(shí),需要關(guān)注患者性別、股骨近端髓腔形態(tài),選擇合適的假體,在手術(shù)中進(jìn)行針對(duì)性的處理,對(duì)非正常髓腔形態(tài)、高齡或女性患者行人工髖關(guān)節(jié)置換時(shí),盡量選擇盡可能合適的假體,避免假體周圍骨折對(duì)患者造成進(jìn)一步更加嚴(yán)重的影響。
[Abstract]:Objective: to observe the correlation between the morphology of proximal femoral medullary cavity and the occurrence of periprosthetic fractures in patients undergoing total hip arthroplasty, and to summarize the causes of periprosthetic fractures after total hip arthroplasty. Pathogenesis and fracture type. In order to predict the possibility of periprosthetic fracture by the shape of proximal medullary cavity, to guide the choice of prosthesis in total hip arthroplasty and to improve the therapeutic effect and safety of total hip replacement. Methods: the cases of patients undergoing total hip arthroplasty from June 2010 to May 2016 were collected, and 500 patients with complete data were selected according to the principle of random distribution. The selection of prosthesis type, the shape of medullary cavity, the occurrence of periprosthetic fractures during and after operation were collected and counted by X-ray images, and the related factors were analyzed by statistical software. The incidence of periprosthetic fracture in patients with different proximal femoral medullary cavity was analyzed. The result is 1: 1. The total number of patients was 500, 340 cases of male and 160 cases of male and female, the age was 41-86 years old, the average age was 69.85 鹵8.74 years old. The imaging examination of all the patients showed that there were 400 cases of normal medullary cavity, 1155 cases of chimney type and 9 cases of inverted champagne type. There were 275 cases of normal medullary cavity in male patients, 30 cases of inverted champagne type and 10.29% of chimney type. Among the female patients, the normal medullary cavity was 78.12 in 125 cases, the inverted champagne type was 9.37 and the chimney type was 12.50.2. In this study, the incidence of periprosthetic fractures was 4, including 10 women and 10 men. The average age of male patients was 75.36 鹵3.51 years old, and that of female patients was 70.23 鹵5.42 years old. Among the 20 cases, 8 cases were champagne type (male 3, female 5), chimney type 8 (male 5, female 3), normal type 4 cases (male 2, female 2). The incidence of periprosthetic fractures were normal type 1, chimney type 14.55 and champagne type 17.78. By statistical analysis, the incidence of female patients was significantly higher than that of men, and the incidence of chimney type and inverted champagne type patients was significantly higher than that of normal type patients, and the difference was statistically significant (P 0.05). Conclusion: the incidence of periprosthetic fractures in female patients is significantly higher than that in male patients, but in the shape of proximal femoral medullary cavity, the incidence of periprosthetic fracture in female patients is significantly higher than that in male patients. The incidence of periprosthetic fracture in the patients with inverted champagne and chimney was significantly higher than that in the normal medullary cavity, and the incidence of periprosthetic fracture in the elderly was significantly higher than that in the young. Therefore, in the clinical implementation of total hip arthroplasty, attention should be paid to the gender of the patient, the shape of the proximal femoral medullary cavity, the selection of the appropriate prosthesis, the targeted treatment during the operation, and the abnormal shape of the medullary cavity. In order to avoid the more serious effect of periprosthetic fracture, we should try to choose the most suitable prosthesis when the elderly or female patients underwent artificial hip replacement.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 秦菲菲;劉雨;賈艷輝;;全髖關(guān)節(jié)置換術(shù)后股骨假體周圍骨折的圍手術(shù)期護(hù)理[J];護(hù)理實(shí)踐與研究;2016年09期

2 姜旭;徐輝;;大粗隆爪鋼板結(jié)合全髖關(guān)節(jié)置換術(shù)治療陳舊性股骨粗隆間骨折12例中期隨訪報(bào)告[J];中國(guó)骨與關(guān)節(jié)雜志;2016年04期

3 劉雙魯;劉蘭波;左建林;肖建林;楊育暉;高忠禮;;成人發(fā)育性髖關(guān)節(jié)發(fā)育不良股骨近端的三維重建及測(cè)量[J];中華外科雜志;2016年04期

4 黃軼剛;金東旭;張長(zhǎng)青;;專用手術(shù)床輔助下前側(cè)入路微創(chuàng)全髖關(guān)節(jié)置換術(shù)的手術(shù)技巧[J];國(guó)際骨科學(xué)雜志;2016年02期

5 王森;;人工全髖關(guān)節(jié)置換治療股骨頭壞死合并股骨近端骨折的效果分析[J];河南醫(yī)學(xué)研究;2016年02期

6 曲振濤;劉青春;張述東;;人工股骨頭置換術(shù)和全髖關(guān)節(jié)置換術(shù)治療老年股骨頸骨折的療效比較[J];中外醫(yī)療;2016年03期

7 俞磊;張成歡;郭亭;丁浩;趙建寧;;全髖關(guān)節(jié)置換術(shù)治療髖臼骨折繼發(fā)創(chuàng)傷性髖關(guān)節(jié)炎和股骨頭壞死中遠(yuǎn)期療效觀察[J];中國(guó)骨傷;2016年02期

8 張蔭坤;何平;龔翰;;全髖關(guān)節(jié)置換術(shù)與半髖關(guān)節(jié)置換術(shù)治療股骨頸骨折的療效比較[J];黑龍江醫(yī)藥;2016年01期

9 張勇;;股骨頸骨折內(nèi)固定治療失敗需行全髖關(guān)節(jié)置換術(shù)的原因探討[J];河北醫(yī)學(xué);2015年12期

10 林龍泉;丁真奇;陳智彪;劉國(guó)俊;陳衛(wèi);陸成武;;初次全髖關(guān)節(jié)置換術(shù)中與生物柄相關(guān)的假體周圍骨折[J];臨床骨科雜志;2015年06期

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