【摘要】：目的:針對(duì)國(guó)際內(nèi)固定協(xié)會(huì)(Association for the study of Internal Fixation,簡(jiǎn)稱AO/ASIF)分型為A1、A2型股骨粗隆間骨折,目前學(xué)界共識(shí)的治療方法是動(dòng)力髖螺釘(Dynamic Hip Screw,簡(jiǎn)稱DHS)和股骨近端防旋髓內(nèi)釘(Proximal Femoral Nail Antirotation,簡(jiǎn)稱PFNA),本文統(tǒng)計(jì)了經(jīng)DHS和PFNA治療的股骨粗隆間骨折患者術(shù)中醫(yī)源性外側(cè)壁骨折的發(fā)生率,分析導(dǎo)致該并發(fā)癥的危險(xiǎn)因素,探討其對(duì)患者骨折愈合及髖關(guān)節(jié)功能的影響,并為臨床治療股骨粗隆間骨折術(shù)中醫(yī)源性外側(cè)壁骨折提供理論依據(jù)。方法:采取臨床病例分析的方法�；仡櫡治�2013年3月—2015年8月間接受DHS或PFNA治療且資料完整的55例股骨粗隆間骨折,兩組患者隨訪時(shí)間均多余1年。其中PFNA組32例,DHS組23例;用觀察性研究方法統(tǒng)計(jì)術(shù)中外側(cè)壁骨折的發(fā)生概率,采用多因素logistic回歸分析各指標(biāo)(年齡、性別、骨折分型、治療方式及是否有內(nèi)科合并癥)與術(shù)中醫(yī)源性外側(cè)壁骨折的關(guān)系;同時(shí)采用兩獨(dú)立樣本t檢驗(yàn)比較二次手術(shù)治療和保守治療(發(fā)生術(shù)中醫(yī)源性外側(cè)壁骨折的患者不接受二次手術(shù)治療)在術(shù)中醫(yī)源性外側(cè)壁骨折患者中的骨折愈合時(shí)間和Harris髖關(guān)節(jié)功能評(píng)分等指標(biāo)。結(jié)果:通過(guò)統(tǒng)計(jì)得出經(jīng)PFNA或DHS治療的股骨粗隆間骨折患者術(shù)中醫(yī)源性外側(cè)壁骨折的發(fā)生率約為18%;且是否發(fā)生術(shù)中醫(yī)源性骨折與患者性別、年齡、治療方式及是否有內(nèi)科合并癥之間無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05),而在不同的骨折分型之間存在統(tǒng)計(jì)學(xué)差異(P=0.018),同時(shí)得出骨折分型等級(jí)越高,術(shù)中醫(yī)源性外側(cè)壁骨折的風(fēng)險(xiǎn)越高;針對(duì)術(shù)中醫(yī)源性外側(cè)壁骨折,二次手術(shù)治療與保守治療相比較,兩者骨折愈合時(shí)間及Harris髖關(guān)節(jié)功能評(píng)分均無(wú)明顯統(tǒng)計(jì)學(xué)差異。結(jié)論:手術(shù)治療(DHS或PFNA)股骨粗隆間骨折均存在術(shù)中醫(yī)源性外側(cè)壁骨折的風(fēng)險(xiǎn);骨折分型是術(shù)中醫(yī)源性外側(cè)壁骨折的危險(xiǎn)因素,骨折分型等級(jí)越高,術(shù)中醫(yī)源性外側(cè)壁骨折的風(fēng)險(xiǎn)越高;針對(duì)術(shù)中醫(yī)源性外側(cè)壁骨折的患者,二次手術(shù)治療與保守治療均為有效的治療方式。
[Abstract]:Objective: to classify the International Association of Internal Fixation (Association for the study of Internal Fixation,) as type A1A _ 2 intertrochanteric fracture. The commonly agreed treatment methods are dynamic hip screw (DHS) and proximal femoral intramedullary nail (Proximal Femoral Nail Antirotation,). The incidence of iatrogenic lateral wall fractures in patients with intertrochanteric femoral fractures treated with DHS and PFNA was analyzed in this paper. To analyze the risk factors leading to the complication, to explore the effect on fracture healing and hip joint function, and to provide theoretical basis for the treatment of iatrogenic lateral wall fracture during intertrochanteric fracture of femur. Methods: to adopt the method of clinical case analysis. 55 cases of intertrochanteric fracture of femur treated indirectly with DHS or PFNA from March 2013 to August 2015 were retrospectively analyzed. The follow-up time of both groups was one year. There were 32 cases in PFNA group and 23 cases in DHS group, and the probability of lateral wall fracture was statistically analyzed by means of observational method and multivariate logistic regression analysis (age, sex, type of fracture). The relationship between treatment and iatrogenic lateral wall fracture; At the same time, two independent samples t test were used to compare the secondary surgical treatment and conservative treatment (the patients with iatrogenic lateral wall fracture did not receive secondary surgical treatment) in the intraoperative patients with iatrogenic lateral wall fracture healing Time and Harris hip function score. Results: the incidence of iatrogenic lateral wall fracture in patients with intertrochanteric fracture treated by PFNA or DHS was about 188.And whether iatrogenic fracture occurred during operation and gender, age, age, There was no significant difference between treatment and internal medical complications (P0.05), but there was statistical difference among different fracture types (P0. 018). At the same time, the higher the grade of fracture classification, the higher the risk of intraoperative iatrogenic lateral wall fracture. For iatrogenic lateral wall fractures, there was no significant difference in fracture healing time and Harris hip function score between secondary surgical treatment and conservative treatment. Conclusion: the risk of intraoperative iatrogenic lateral wall fracture exists in surgical treatment (DHS or PFNA) of intertrochanteric fracture, the classification of fracture is the risk factor of intraoperative iatrogenic lateral wall fracture, and the higher the classification grade is, the higher the classification is. The higher the risk of intraoperative iatrogenic lateral wall fracture is, the more effective treatment is for the patients with iatrogenic lateral wall fracture.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

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