【摘要】：背景:臨床中若老年股骨轉(zhuǎn)子間骨折患者出現(xiàn)不穩(wěn)定性股骨轉(zhuǎn)子間骨折則優(yōu)先考慮髓內(nèi)釘治療;但患者為穩(wěn)定性股骨轉(zhuǎn)子間骨折時,髓外固定或髓內(nèi)固定均可起到較好的修復效果,因而臨床中如何選取內(nèi)固定方案仍存在較大爭議。目的:探討經(jīng)皮加壓鋼板與股骨近端防旋髓內(nèi)釘內(nèi)固定對老年穩(wěn)定性股骨轉(zhuǎn)子間骨折患者術(shù)后功能恢復的影響及患者術(shù)后股骨頭旋轉(zhuǎn)、固定釘滑脫情況,為臨床選擇提供依據(jù)。方法:將86例老年穩(wěn)定性股骨轉(zhuǎn)子間骨折患者隨機分為2組,經(jīng)皮加壓鋼板組患者進行經(jīng)皮加壓鋼板內(nèi)固定治療,股骨近端防旋髓內(nèi)釘組進行股骨近端防旋髓內(nèi)釘內(nèi)固定治療。記錄手術(shù)時間、術(shù)中出血量、術(shù)后血紅蛋白下降量、患者下地負重時間及骨折愈合時間,并在術(shù)后4周時使用Harris評分系統(tǒng)對患者功能恢復情況進行評估,此外對患者術(shù)后4周時股骨頭旋轉(zhuǎn)率、固定釘滑脫量和術(shù)后6個月內(nèi)出現(xiàn)的并發(fā)癥進行統(tǒng)計。結(jié)果與結(jié)論:(1)股骨近端防旋髓內(nèi)釘組患者術(shù)中出血量及術(shù)后血紅蛋白下降量均顯著高于經(jīng)皮加壓鋼板組(P0.05);(2)2組患者術(shù)后4周時Harris評分差異無顯著性意義(P0.05);股骨近端防旋髓內(nèi)釘組下地負重時間、骨折愈合時間均顯著短于經(jīng)皮加壓鋼板組(P0.05);(3)術(shù)后4周時經(jīng)皮加壓鋼板組患者股骨頭旋轉(zhuǎn)率及固定釘滑脫量均顯著高于股骨近端防旋髓內(nèi)釘組(P0.05);(4)2組患者術(shù)后6個月內(nèi)的并發(fā)癥發(fā)生率差異無顯著性意義(P0.05);(5)結(jié)果表明,經(jīng)皮加壓鋼板和股骨近端防旋髓內(nèi)釘內(nèi)固定修復老年穩(wěn)定性股骨轉(zhuǎn)子間骨折時,患者術(shù)后功能恢復及術(shù)后并發(fā)癥無明顯差異;但在患者股骨頭旋轉(zhuǎn)率和固定釘滑脫量方面股骨近端防旋髓內(nèi)釘更具優(yōu)勢。
[Abstract]:Background: if unstable intertrochanteric fracture occurs in elderly patients with intertrochanteric fracture, intramedullary nail treatment is preferred. But when the patient is a stable femoral intertrochanteric fracture, the external fixation or intramedullary fixation can play a better effect, so how to select the internal fixation is still controversial. Objective: to investigate the effect of percutaneous compression plate and intramedullary nail fixation on the functional recovery of elderly patients with stable intertrochanteric fracture and to provide evidence for clinical selection. Methods: 86 elderly patients with stable intertrochanteric fracture of femur were randomly divided into two groups. The patients in the percutaneous compression plate group were treated with percutaneous compression plate internal fixation, and the proximal femoral anti-rotation intramedullary nail group was treated with the proximal femoral anti-rotation intramedullary nail. The time of operation, the amount of blood lost during operation, the decrease of hemoglobin after operation, the time of weight loading and the time of fracture healing were recorded. The functional recovery of the patients was evaluated by Harris scoring system 4 weeks after operation. In addition, the rate of femoral head rotation, the amount of fixation nail slippage and the complications occurred within 6 months after operation were analyzed. Results and conclusion: (1) the amount of intraoperative blood loss and the decrease of hemoglobin in the proximal femoral intramedullary nail group were significantly higher than those in the percutaneous compression plate group (P0.05). (2) there was no significant difference in Harris score between the two groups at 4 weeks after operation (P0.05), and the time of weight loading and fracture healing in the proximal femur anti-rotation intramedullary nail group was significantly shorter than that in the percutaneous compression plate group (P0.05). (3) at 4 weeks after operation, the femoral head rotation rate and fixation nail detachment in the percutaneous compression plate group were significantly higher than those in the proximal femoral anti-rotation intramedullary nail group (P0.05). (4) there was no significant difference in the incidence of complications within 6 months after operation between the two groups (P0.05). (5) the results showed that there was no significant difference in postoperative functional recovery and postoperative complications in the treatment of senile stable intertrochanteric fractures with percutaneous compression plate and intramedullary nail fixation. However, the femoral head rotation rate and the amount of fixation nail slippage are superior in the proximal femur anti-rotation intramedullary nail.
【作者單位】： 東南大學醫(yī)學院附屬江陰醫(yī)院骨科;
【基金】：基金資助:2012年江蘇省衛(wèi)生廳醫(yī)學新技術(shù)引進二等獎(蘇衛(wèi)科教(2012)11號),引進技術(shù)名稱:經(jīng)皮加壓鋼板(PCCP)治療老年股骨轉(zhuǎn)子間骨折的臨床應用~~
【分類號】：R687.3
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本文編號：2354640