發(fā)布時間：2018-06-07 00:42

  本文選題：股骨骨折 + 內(nèi)固定器��； 參考：《中國組織工程研究》2017年19期

【摘要】：背景:股骨頸骨折仍然被認(rèn)為是一種尚未解決的疾病,主要原因在于是采取內(nèi)固定還是采用犧牲解剖結(jié)構(gòu)的關(guān)節(jié)置換手術(shù)一直存在爭議。這種爭議來源于采用內(nèi)固定治療可能出現(xiàn)骨不連和股骨頭缺血壞死,從而帶來遠(yuǎn)期功能恢復(fù)的不滿意。是否能通過骨折良好復(fù)位,確切固定以及積極功能鍛煉改善預(yù)期呢?如果可能,那將有益于老年股骨頸骨折,特別是本身合并嚴(yán)重基礎(chǔ)疾病的患者恢復(fù)。目的:比較植入物內(nèi)固定與半髖置換修復(fù)老年新鮮股骨頸骨折患者生活質(zhì)量的差異。方法:回顧性分析2010年1月至2013年12月大連醫(yī)科大學(xué)附屬第一醫(yī)院收治的148例大于60歲的股骨頸骨折患者,比較內(nèi)固定和半髖置換分別在無移位型(GardenⅠ、GardenⅡ型)及移位型(GardenⅢ、GardenⅣ型)股骨頸骨折患者手術(shù)時間、出血量、住院時間、死亡率、再手術(shù)率及術(shù)后生活質(zhì)量的差異,術(shù)后生活質(zhì)量采用Harris評分及SF-36量表評估。結(jié)果與結(jié)論:(1)148例患者中137例獲得隨訪,隨訪率92.6%;(2)手術(shù)時間、術(shù)中出血量和住院時間比較,不論是無移位型,還是移位型股骨頸骨折,均為內(nèi)固定組明顯優(yōu)于半髖置換組(P0.05);(3)兩種修復(fù)方式死亡率差異無顯著性意義,再手術(shù)率內(nèi)固定組略高于半髖置換組;(4)兩種修復(fù)方式術(shù)后的Harris評分及SF-36評分均隨著時間的延長而升高,2組間的差距隨著時間的延長而不斷接近,于術(shù)后2.5年即可達到相等(P0.05),且內(nèi)固定術(shù)修復(fù)無移位型股骨頸骨折比移位型可更早獲得與半髖置換相同的生活質(zhì)量;(5)結(jié)果表明,植入物內(nèi)固定在修復(fù)老年股骨頸骨折上,具有手術(shù)時間短、操作簡單、創(chuàng)傷小等明顯的優(yōu)勢,并且保留了自身股骨頭,在術(shù)后2.5年即可達到與半髖關(guān)節(jié)置換相同的生活質(zhì)量;尤其是隨著科技的發(fā)展和手術(shù)技術(shù)的成熟,當(dāng)代內(nèi)固定術(shù)完全可以滿足患者術(shù)后早期下地的需求,使其優(yōu)勢更加突出。因此,植入物內(nèi)固定是修復(fù)老年股骨頸骨折的有效方法。
[Abstract]:Background: femoral neck fractures are still considered to be an unsolved disease, mainly due to the controversy over whether to use internal fixation or arthroplasty with sacrificial anatomical structures. This controversy stems from the possibility of nonunion and avascular necrosis of the femoral head after internal fixation, which results in unsatisfactory long-term functional recovery. Is it possible to improve expectations through good fracture reduction, precise fixation, and active functional exercise? If possible, it will benefit elderly patients with femoral neck fractures, especially if they are associated with severe underlying diseases. Objective: to compare the quality of life (QOL) between implants and hemihip arthroplasty in the repair of fresh femoral neck fractures. Methods: from January 2010 to December 2013, 148 patients with femoral neck fractures aged more than 60 years were treated in the first affiliated Hospital of Dalian Medical University. The operative time, bleeding volume, hospital stay, mortality, reoperation rate and quality of life of the patients with femoral neck fracture were compared between internal fixation and half hip replacement in Garden 鈪，

本文編號：1988891