本文選題：股骨粗隆間骨折 + 小切口��； 參考：《遵義醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:對(duì)比分析小切口解剖鎖定加壓鈦板與PFNA手術(shù)對(duì)老年股骨粗隆間骨折的療效差異。方法:回顧性分析我院2010.11-2014.11資料完整的102例手術(shù)治療老年股骨粗隆間骨折的患者,其中小切口解剖鎖定加壓鈦板手術(shù)治療(鈦板組)53例:男性16例,女性37例,平均年齡75.3歲。PFNA手術(shù)治療(PFNA組)49例:男性18例,女性31例,平均年齡74.9歲。兩組手術(shù)均由同一治療小組完成,其中主任醫(yī)師一名,副主任醫(yī)師一名,主治醫(yī)師一名,住院醫(yī)師三名。不存在手術(shù)技巧及治療方面的差異。統(tǒng)計(jì)兩組患者術(shù)中X線透視次數(shù)、手術(shù)時(shí)間、術(shù)中及術(shù)后顯性出血量,隱性出血量,總出血量、術(shù)后內(nèi)固定失敗率、術(shù)后下肢深靜脈血栓形成率、住院時(shí)間、負(fù)重時(shí)間、骨折愈合時(shí)間及術(shù)后6、12、18個(gè)月Harris評(píng)分等相關(guān)數(shù)據(jù)。結(jié)果:102例患者均獲得18-24個(gè)月隨訪,平均22.5個(gè)月。兩組患者負(fù)重時(shí)間比較,PFNA組14.3±1.8d,鈦板組30.4±2.6d,PFNA組時(shí)間短于鈦板組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者在X線透視次數(shù)、隱性出血量及總出血量比較,鈦板組分別為4.5±1.2次、334.6±122.6ml、519.8±142.4ml,PFNA組分別為8.9±1.4次、448.6±156.6ml、595.3±185.3ml,兩組數(shù)據(jù)比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者在手術(shù)時(shí)間、住院時(shí)間、骨折愈合時(shí)間、術(shù)后內(nèi)固定失敗率、術(shù)后下肢深靜脈血栓形成率比較,鈦板組分別為75.8±13.2min、19.2±1.0d、85.4±10.6d、1.89%、3.77%,PFNA組分別為76.3±12.1min、18.9±1.3d、84.7±12.4d、2.04%、4.08%,兩組比較無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。兩組患者在術(shù)后6、12、18個(gè)月Harris評(píng)分,鈦板組分別為78.4±7.4、84.3±4.7、87.2±4.4,PFNA組分別為77.9±9.3、85.5±7.3、87.4±3.6,兩組比較無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:對(duì)于老年股骨粗隆間骨折患者,PFNA手術(shù)治療有下地負(fù)重時(shí)間早的優(yōu)點(diǎn)。小切口解剖鎖定加壓鈦板手術(shù)治療有術(shù)中進(jìn)行X線透視次數(shù)少、隱性出血量及總出血量少的優(yōu)點(diǎn)。小切口解剖鎖定加壓鈦板內(nèi)固定是治療老年股骨粗隆間骨折又一個(gè)較理想的術(shù)式選擇。
[Abstract]:Objective: to compare and analyze the curative effect of small incision anatomic locking compression titanium plate and PFNA operation on intertrochanteric fracture of femur in elderly patients. Methods: 102 patients with intertrochanteric fracture of femur in our hospital were analyzed retrospectively. Among them, 53 cases were treated with small incision anatomic locking compression titanium plate (titanium plate group: 16 males and 37 females). The mean age was 75.3 years. The mean age of PFNA group was 74.9 years old. There were 18 males and 31 females with an average age of 74.9 years. The two groups were performed by the same treatment group, including one chief physician, one deputy chief physician, one attending physician and three resident doctors. There is no difference in surgical skill and treatment. The number of times of X-ray fluoroscopy, the time of operation, the amount of dominant bleeding during and after operation, the amount of recessive bleeding, the total amount of bleeding, the failure rate of internal fixation, the rate of thrombosis of deep vein of lower extremity, the time of hospitalization, the time of weight bearing, the rate of postoperative deep vein thrombosis were counted. Fracture healing time and Harris score at 612 and 18 months after operation. Results all 102 patients were followed up for 18-24 months with an average of 22. 5 months. The time of loading weight in PFNA group was 14.3 鹵1.8 days, that in titanium plate group was 30.4 鹵2.6 days longer than that in titanium plate group, the difference was statistically significant (P 0.05). The frequency of X-ray fluoroscopy, the amount of recessive bleeding and the total amount of bleeding in the two groups were 4.5 鹵1.2 times, 334.6 鹵122.6 ml / time, 519.8 鹵142.4 ml / PFNA, 8.9 鹵1.4 times, respectively, respectively. The difference between the two groups was statistically significant (P 0.05). The time of operation, the time of hospitalization, the time of fracture healing, the failure rate of internal fixation and the rate of deep vein thrombosis in the titanium plate group were 75.8 鹵13.2 min and 19.2 鹵1.0 d respectively, and those in the PFNA group were 76.3 鹵12.1min, 84.7 鹵12.4 days, 2.04d, 4.08, respectively. There was no significant difference between the two groups (P 0.05). The Harris scores of the two groups were 78.4 鹵7.4 鹵7.4 鹵4.4 鹵7.4 鹵3.6 at 612 and 18 months after operation, respectively, and 77.9 鹵9.3 鹵9.3 鹵85.5 鹵7.3 鹵87.4 鹵3.6 in the titanium plate group, respectively. There was no significant difference between the two groups (P 0.05). Conclusion: PFNA has the advantage of early loading time for elderly patients with intertrochanteric fracture of femur. Small incision anatomic locking pressurized titanium plate has the advantages of less X-ray fluoroscopy, less recessive bleeding and less total bleeding. Small incision anatomic locking compression titanium plate fixation is an ideal choice for the treatment of senile intertrochanteric fracture.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R687.3

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