發(fā)布時(shí)間：2018-09-15 18:55

【摘要】：目的本臨床研究的目的是回顧性評(píng)價(jià)PFNA與InterTAN治療老年骨質(zhì)疏松性不穩(wěn)定型股骨轉(zhuǎn)子間骨折的臨床療效,通過(guò)分析臨床數(shù)據(jù)和討論兩種內(nèi)固定的特點(diǎn),以比較兩種內(nèi)固定方式在臨床運(yùn)用中的優(yōu)劣性。方法(1)分組：收集2013年6月—2014年12月四川省人民醫(yī)院骨科住院的且滿(mǎn)足納入標(biāo)準(zhǔn)的老年骨質(zhì)疏松性不穩(wěn)定型股骨轉(zhuǎn)子間骨折37例患者。(2)方法：19例患者采用PFNA治療,18例患者采用InterTAN治療,術(shù)后兩組患者均給予同樣的治療方法和功能康復(fù)。(3)觀察內(nèi)容：比較兩組患者的手術(shù)時(shí)間、術(shù)中出血量、術(shù)后引流量、切口長(zhǎng)度、住院時(shí)間、骨折臨床愈合時(shí)間、內(nèi)固定穩(wěn)定性以及術(shù)后髖關(guān)節(jié)功能Harris評(píng)分。結(jié)果術(shù)后隨訪(fǎng)3個(gè)月～15個(gè)月,平均9.6個(gè)月。(1)通過(guò)比較手術(shù)時(shí)間、術(shù)中出血量、術(shù)后引流量及骨折臨床愈合時(shí)間,可以得出兩組數(shù)據(jù)有差異(P0.05),具有統(tǒng)計(jì)學(xué)意義,說(shuō)明了PFNA組比InterTAN組手術(shù)時(shí)間短、術(shù)中出血少及術(shù)后引流量少,InterTAN組比PFNA組骨折臨床愈合時(shí)間短。(2)在內(nèi)固定穩(wěn)定性方面,PFNA組出現(xiàn)1例螺旋刀片退出,InterTAN組無(wú)螺釘退出,但兩組數(shù)據(jù)差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),這可能與收集的病例數(shù)量不多有關(guān),需要進(jìn)一步大樣本研究,因此InterTAN比PFNA的穩(wěn)定性可能更好。(3)通過(guò)比較切口長(zhǎng)度、住院時(shí)間及術(shù)后髖關(guān)節(jié)功能Harris評(píng)分,可以得出兩組數(shù)據(jù)無(wú)差異(P0.05),不具有統(tǒng)計(jì)學(xué)意義,說(shuō)明了PFNA組與InterTAN組在切口長(zhǎng)度、住院時(shí)間及術(shù)后髖關(guān)節(jié)功能Harris評(píng)分方面相近。結(jié)論(1)在老年骨質(zhì)疏松性不穩(wěn)定型股骨轉(zhuǎn)子間骨折的治療上,PFNA與InterTAN都是安全有效的內(nèi)固定方式,均具有手術(shù)創(chuàng)傷小、術(shù)中出血量少、術(shù)后引流量少、骨折固定牢靠、住院時(shí)間短及功能恢復(fù)好的優(yōu)點(diǎn)。(2)PFNA與InterTAN相互比較,又各有優(yōu)缺點(diǎn)。與InterTAN比較,PFNA的術(shù)中操作更加簡(jiǎn)潔方便、手術(shù)時(shí)間更短、術(shù)中出血量更少及術(shù)后引流量更少。與PFNA比較,InterTAN的骨折臨床愈合時(shí)間更短及穩(wěn)定性可能更好。
[Abstract]:Objective to evaluate the clinical efficacy of PFNA and InterTAN in the treatment of unstable femoral intertrochanteric fracture in elderly patients, and to analyze the clinical data and discuss the characteristics of two internal fixation methods. To compare the advantages and disadvantages of two internal fixation methods in clinical application. Methods (1) A total of 37 elderly patients with unstable femoral intertrochanteric fractures were collected from orthopaedic department of Sichuan Provincial people's Hospital from June 2013 to December 2014. (2) methods: 19 patients were treated with PFNA. 18 patients were treated with InterTAN. The two groups were given the same treatment method and functional rehabilitation. (3) observation: the operation time, intraoperative blood loss, postoperative drainage, incision length, hospital stay, fracture clinical healing time were compared between the two groups. Stability of internal fixation and Harris score of hip function after operation. Results the postoperative follow-up ranged from 3 months to 15 months with an average of 9.6 months. (1) by comparing the operative time, intraoperative bleeding volume, postoperative drainage volume and fracture healing time, the data of the two groups were significantly different (P0.05). The results showed that the operation time of PFNA group was shorter than that of InterTAN group, and the healing time of intern group was shorter than that of PFNA group. However, the difference between the two groups was not statistically significant (P0.05), which may be related to the small number of cases collected, so the stability of InterTAN may be better than that of PFNA. (3) by comparing the length of incision, Hospitalization time and postoperative hip function Harris score, can be obtained two groups of data have no difference (P0.05), there is no statistical significance, indicating that PFNA group and InterTAN group in incision length, hospitalization time and postoperative hip function Harris score is similar. Conclusion (1) both InterTAN and PFNA are safe and effective internal fixation methods in the treatment of unstable femoral intertrochanteric fractures in the elderly. Both have the advantages of less operative trauma, less intraoperative bleeding, less postoperative drainage and reliable fixation. The advantages of short hospitalization time and good functional recovery. (2) compared with InterTAN, PFNA has its own advantages and disadvantages. Compared with InterTAN, the intraoperative operation was more simple and convenient, the operation time was shorter, the amount of intraoperative bleeding was less and the postoperative drainage was less. The clinical healing time and stability of intertan fracture were shorter and more stable than PFNA.
【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R687.3

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