防旋型股骨近端髓內(nèi)釘（PFNA-Ⅱ）置入與人工髖關(guān)節(jié)置換治療高齡轉(zhuǎn)子間骨折的療效觀察
發(fā)布時間：2018-08-11 21:43
【摘要】：背景：針對≥80歲的高齡轉(zhuǎn)子間骨折患者采用內(nèi)固定還是人工髖關(guān)節(jié)置換治療,存在爭議。本研究通過對PFNA-II置入和人工髖關(guān)節(jié)置換治療高齡股骨轉(zhuǎn)子間骨折的療效進行對比分析,希望能給臨床工作提供一些參考。方法：回顧性分析173例高齡轉(zhuǎn)子間骨折患者的臨床資料,其中PFNA-II置入治療59例,年齡80-94歲；人工髖關(guān)節(jié)置換治療114例,年齡80-103歲。對手術(shù)時間、失血量、住院和臥床時間、術(shù)后并發(fā)癥和髖關(guān)節(jié)功能等進行比較。結(jié)果：除1例患者術(shù)中死亡外,其余172例患者術(shù)后隨訪7-48月。PFNA-II置入組的手術(shù)時間(P0.05),術(shù)中失血量(P0.0001)和術(shù)后隱性失血量(P0.0001)明顯小于人工髖關(guān)節(jié)置換組,但PFNA-II組下地時間較人工髖關(guān)節(jié)置換組晚(P0.0001),在住院時間、術(shù)后并發(fā)癥和術(shù)后一年的髖關(guān)節(jié)功能方面均無明顯差異(P0.05)。結(jié)論：1.PFNA-II置入與髖關(guān)節(jié)置換治療高齡轉(zhuǎn)子間骨折,PFNA-II置入在手術(shù)時間、術(shù)中術(shù)后失血方面優(yōu)于髖關(guān)節(jié)置換,尤其是穩(wěn)定型骨折；髖關(guān)節(jié)置換術(shù)后臥床時間短,但在術(shù)后并發(fā)癥發(fā)生率和髖關(guān)節(jié)功能方面無明顯差異。除大轉(zhuǎn)子和外側(cè)壁均嚴(yán)重破壞的不穩(wěn)定型骨折以及術(shù)前有髖部疾病者,均可考慮首選PFNA-II置入治療。2.對于嚴(yán)重骨質(zhì)疏松的不穩(wěn)定型轉(zhuǎn)子間骨折患者,一直以來都首選髖關(guān)節(jié)置換。本研究中PFNA-II置入組合并骨質(zhì)疏松的患者并沒有隨訪到嚴(yán)重的局部并發(fā)癥,此類患者今后可嘗試PFNA-II置入,同時系統(tǒng)地抗骨質(zhì)疏松治療。3.圍手術(shù)期全面檢查、處理內(nèi)科合并癥,糾正失血,PFNA-II置入術(shù)后注重早期床上功能鍛煉,髖關(guān)節(jié)置換術(shù)后注重早期下床功能鍛煉,防止長期臥床并發(fā)癥同時也有利于關(guān)節(jié)功能恢復(fù)。
[Abstract]:BACKGROUND: It is controversial whether internal fixation or hip arthroplasty should be used in the treatment of intertrochanteric fractures in elderly patients over 80 years of age. The clinical data of 73 elderly patients with intertrochanteric fractures were analyzed.Fifty-nine patients aged 80-94 were treated with PFNA-II implantation and 114 patients aged 80-103 were treated with hip replacement. The postoperative follow-up was 7-48 months. The operative time (P 0.05), intraoperative blood loss (P 0.0001) and postoperative occult blood loss (P 0.0001) in PFNA-II group were significantly less than those in the artificial hip replacement group, but the lower floor time in PFNA-II group was later than that in the artificial hip replacement group (P 0.0001), and there was no significant difference in hospitalization time, postoperative complications and hip function one year after operation. Conclusion: 1. PFNA-II implantation and hip replacement in the treatment of intertrochanteric fractures in elderly patients, PFNA-II implantation in the operation time, intraoperative and postoperative blood loss is superior to hip replacement, especially for stable fractures; hip replacement after bed time is short, but there is no significant difference in the incidence of postoperative complications and hip function. PFNA-II implantation is the preferred treatment for unstable fractures with severe destruction of the greater trochanter and lateral wall, and for patients with preoperative hip disease. 2. For unstable intertrochanteric fractures with severe osteoporosis, hip replacement has always been the preferred treatment. Patients with PFNA-II implantation and osteoporosis in this study were not followed up. Severe local complications, such patients can try PFNA-II implantation in the future, while systemic anti-osteoporosis treatment. 3. Perioperative comprehensive examination, treatment of medical complications, correction of blood loss, PFNA-II implantation after early bed function exercise, hip replacement after early bed function exercise, to prevent long-term complications of the same. It is also beneficial to the recovery of joint function.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3
[Abstract]:BACKGROUND: It is controversial whether internal fixation or hip arthroplasty should be used in the treatment of intertrochanteric fractures in elderly patients over 80 years of age. The clinical data of 73 elderly patients with intertrochanteric fractures were analyzed.Fifty-nine patients aged 80-94 were treated with PFNA-II implantation and 114 patients aged 80-103 were treated with hip replacement. The postoperative follow-up was 7-48 months. The operative time (P 0.05), intraoperative blood loss (P 0.0001) and postoperative occult blood loss (P 0.0001) in PFNA-II group were significantly less than those in the artificial hip replacement group, but the lower floor time in PFNA-II group was later than that in the artificial hip replacement group (P 0.0001), and there was no significant difference in hospitalization time, postoperative complications and hip function one year after operation. Conclusion: 1. PFNA-II implantation and hip replacement in the treatment of intertrochanteric fractures in elderly patients, PFNA-II implantation in the operation time, intraoperative and postoperative blood loss is superior to hip replacement, especially for stable fractures; hip replacement after bed time is short, but there is no significant difference in the incidence of postoperative complications and hip function. PFNA-II implantation is the preferred treatment for unstable fractures with severe destruction of the greater trochanter and lateral wall, and for patients with preoperative hip disease. 2. For unstable intertrochanteric fractures with severe osteoporosis, hip replacement has always been the preferred treatment. Patients with PFNA-II implantation and osteoporosis in this study were not followed up. Severe local complications, such patients can try PFNA-II implantation in the future, while systemic anti-osteoporosis treatment. 3. Perioperative comprehensive examination, treatment of medical complications, correction of blood loss, PFNA-II implantation after early bed function exercise, hip replacement after early bed function exercise, to prevent long-term complications of the same. It is also beneficial to the recovery of joint function.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3
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