【摘要】：目的比較采用人工股骨頭置換與ITST股骨粗隆間/粗隆下髓內(nèi)釘(ITST Intertrochanteric Subtrochanteric Interamedullary Femoral Fixation,以下簡稱ITST)治療高齡不同類型股骨轉(zhuǎn)子間骨折的臨床療效,評價人工股骨頭置換及ITST髓內(nèi)釘兩種術(shù)式治療高齡不同類型股骨轉(zhuǎn)子間骨折的效果,為高齡不同類型股骨轉(zhuǎn)子間骨折臨床合理選擇手術(shù)方式提供參考。方法選擇廣西醫(yī)科大學(xué)第四附屬醫(yī)院關(guān)節(jié)外科自2011年1月-2014年1月間住院采用人工股骨頭置換術(shù)或ITST股骨粗隆間/粗隆下髓內(nèi)釘(ITST)治療的年齡≥80歲股骨轉(zhuǎn)子間骨折患者為研究對象,根據(jù)納入標(biāo)準(zhǔn)共選出符合條件的患者76例,其中女性42例,男性34例,年齡80-101歲,平均86.3歲。按Evans骨折分型是否穩(wěn)定分為穩(wěn)定型組36例和不穩(wěn)定型組40例,每組再根據(jù)選擇手術(shù)方式的不同分為兩組：其中穩(wěn)定型組人工股骨頭置換19例、ITST內(nèi)固定17例；不穩(wěn)定型組人工股骨頭置換22例、ITST內(nèi)固定18例,分析比較穩(wěn)定型與不穩(wěn)定型股骨轉(zhuǎn)子間骨折患者分別采用人工股骨頭置換、ITST在手術(shù)時間、術(shù)中出血量、術(shù)后引流量、下床時間、住院時間、負(fù)重時間、術(shù)后1個月、6個月和12個月髖關(guān)節(jié)Harris評分、術(shù)后1年內(nèi)并發(fā)癥、優(yōu)良率。對入選患者進(jìn)行隨訪并及時記錄,資料收集包括查閱病歷、電話隨訪、門診復(fù)診、上門隨訪等。結(jié)果所有患者均獲得隨訪,隨訪時間12-32個月,平均19.7個月。穩(wěn)定型組中在平均手術(shù)時間、術(shù)中出血量、術(shù)后引流量方面,ITST內(nèi)固定優(yōu)于人工股骨頭置換,兩組經(jīng)統(tǒng)計(jì)學(xué)處理組間有明顯差異(P0.05),兩種手術(shù)方式在術(shù)后下床時間、住院時間、術(shù)后6個月、12個月髖關(guān)節(jié)Harris評分、術(shù)后1年內(nèi)并發(fā)癥、術(shù)后1年髖關(guān)節(jié)功能優(yōu)良率方面組間比較無顯著性差異(P0.05)；在術(shù)后1個月髖關(guān)節(jié)Harris評分人工股骨頭置換優(yōu)于ITST內(nèi)固定,負(fù)重時間股骨頭置換術(shù)短于ITST內(nèi)固定術(shù),差異有統(tǒng)計(jì)學(xué)意義(P0.05)；在不穩(wěn)定型骨折組中,兩種術(shù)式在手術(shù)時間、住院時間方面無顯著性差異(P0.05),術(shù)中出血量、術(shù)后引流量方面,ITST內(nèi)固定優(yōu)于人工股骨頭置換,兩組經(jīng)統(tǒng)計(jì)學(xué)處理組間有統(tǒng)計(jì)學(xué)差異(P0.05),人工股骨頭置換在下床時間、負(fù)重時間、術(shù)后1個月髖關(guān)節(jié)Harris評分方面均顯示優(yōu)于ITST內(nèi)固定,組間比較有顯著性差異(P0.05),人工股骨頭置換術(shù)后6個月、12個月髖關(guān)節(jié)Harris評分、術(shù)后1年髖關(guān)節(jié)優(yōu)良率稍優(yōu)于ITST內(nèi)固定,組間比較無明顯差異(P0.05),術(shù)后并發(fā)癥方面：兩組總并發(fā)癥發(fā)生率股骨頭置換為9.09%,ITST內(nèi)固定為16.67%,組間差別有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1、對于高齡穩(wěn)定型股骨轉(zhuǎn)子間骨折(Evans一類Ⅰ型、Ⅱ型),人工股骨頭置換及ITST內(nèi)固定均能取得良好的臨床療效,但人工股骨頭置換手術(shù)創(chuàng)傷較ITST髓內(nèi)釘大,對于穩(wěn)定型骨折,建議選擇髓內(nèi)固定治療。2、對于高齡不穩(wěn)定型股骨轉(zhuǎn)子間骨折(Evans一類Ⅲ型、Ⅳ型)、伴有嚴(yán)重骨質(zhì)疏松、基礎(chǔ)疾病多不宜長期臥床的股骨轉(zhuǎn)子間骨折患者,人工股骨頭置換在術(shù)后早期下床時間、髖關(guān)節(jié)功能恢復(fù)、并發(fā)癥較ITST髓內(nèi)釘療效明顯,可盡快恢復(fù)患者傷前的髖關(guān)節(jié)功能,早期下地活動、明顯減少臥床時間長而引起的并發(fā)癥,能更好的提高老年患者的生活質(zhì)量,是一種有效的手術(shù)方法,但應(yīng)嚴(yán)格把握手術(shù)適應(yīng)癥。
[Abstract]:Objective To compare the clinical effects of artificial femoral head replacement and ITST intertrochanteric Subtrochanteric Interamedullary Femoral Fixation (ITST) in the treatment of different types of intertrochanteric fractures in the elderly, and to evaluate the effect of ITST and ITST intramedullary nail in the treatment of the elderly. Methods Artificial femoral head replacement or ITST intertrochanteric/subtrochanteric intramedullary nail (ITST) were performed in the Department of Arthroplasty of the Fourth Affiliated Hospital of Guangxi Medical University from January 2011 to January 2014. According to the inclusion criteria, 76 patients with femoral intertrochanteric fractures aged 80 years or older were selected, including 42 females, 34 males, aged 80-101, with an average age of 86.3 years. They were divided into two groups: 19 cases of artificial femoral head replacement and 17 cases of ITST internal fixation in stable group, 22 cases of artificial femoral head replacement and 18 cases of ITST internal fixation in unstable group. All patients were followed up for 12-32 months, including medical records, telephone follow-up, outpatient follow-up, home follow-up and so on. In the stable group, ITST internal fixation was superior to artificial femoral head replacement in terms of average operation time, intraoperative bleeding volume and postoperative drainage volume. There was significant difference between the two groups (P There was no significant difference in the excellent and good rate of hip function between the two groups (P 0.05) at 1 month after operation, and the artificial femoral head replacement was superior to ITST internal fixation in the Harris score of hip joint, and the load-bearing time was shorter than ITST internal fixation, the difference was statistically significant (P 0.05). There was no significant difference in operation time and hospitalization time (P 0.05). In terms of bleeding volume and drainage volume, ITST internal fixation was superior to artificial femoral head replacement. There was statistical difference between the two groups (P 0.05). Artificial femoral head replacement was superior to ITST in bed time, weight-bearing time, and Harris score of hip joint at 1 month after operation. Internal fixation, there was a significant difference between groups (P 0.05), 6 months after artificial femoral head replacement, 12 months after the Harris hip score, 1 year after the hip joint good rate slightly better than ITST internal fixation, there was no significant difference between groups (P 0.05). Postoperative complications: two groups of total complications rate of femoral head replacement was 9.09%, ITST internal fixation was 16.67%. Conclusion 1. For elderly patients with stable intertrochanteric fractures (Evans type I, type II), artificial femoral head replacement and ITST internal fixation can achieve good clinical efficacy, but the surgical trauma of artificial femoral head replacement is greater than ITST intramedullary nail. For stable fractures, intramedullary fixation is recommended. For elderly patients with unstable intertrochanteric fractures (Evans type III, type IV) accompanied by severe osteoporosis, most of the underlying diseases are not suitable for long-term bedridden intertrochanteric fractures, artificial femoral head replacement in the early postoperative bed time, hip function recovery, complications than ITST intramedullary nail curative effect is obvious, can recover patients as soon as possible before injury. It is an effective surgical method to reduce the complications caused by prolonged bed rest and improve the quality of life of elderly patients. However, the indication of operation should be strictly controlled.
【學(xué)位授予單位】：廣西醫(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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