【摘要】：目的:從手術(shù)操作時長、術(shù)中出血總量、術(shù)后并發(fā)癥情況及術(shù)后下地活動時間,以及術(shù)后Harris評分等方面,把防旋股骨近端髓內(nèi)釘(PFNA)和人工全髖關(guān)節(jié)置換(THA)治療老年不穩(wěn)定型股骨粗隆間骨折進(jìn)行臨床療效上的比較,討論兩種術(shù)式治療老年不穩(wěn)定型股骨粗隆間骨折的適應(yīng)癥,分析兩種手術(shù)方式與股骨粗隆間骨折分型的關(guān)系,為老年不穩(wěn)定型股骨粗隆間骨折選擇何種術(shù)式最佳提供了理論依據(jù)。方法:對2012年1月-2016年1月在武漢市武東醫(yī)院外科住院的78例老年不穩(wěn)定型股骨粗隆間骨折患者分別采用防旋股骨近端髓內(nèi)釘(PFNA)30例和人工全髖關(guān)節(jié)置換術(shù)(THA)治療48例進(jìn)行了回顧性分析,其中女性患者32例,男性患者46例,年齡介于67歲至89歲之間,平均年齡76.54歲。Evans分型,Ⅲ型30例、Ⅳ型39例,V型9例。術(shù)前準(zhǔn)備5至7天,對移位嚴(yán)重或有嵌插的骨折,行患側(cè)脛骨結(jié)節(jié)骨牽引術(shù)。分組:A組(PFNA):30例,其中13例為女性患者、男性患者有17例,年齡67至83歲,平均年齡73.46歲;B組(THA):48例,其中19例為女性患者、男性患者為29例,年齡69至89歲,平均年齡79.62歲。對手術(shù)操作時長、術(shù)中出血總量、術(shù)后并發(fā)癥情況及術(shù)后下地活動時間,以及術(shù)后Harris評分結(jié)果進(jìn)行臨床療效統(tǒng)計(jì)分析。結(jié)果:本組78例患者中,67例患者積極配合隨訪,且隨訪資料完整可靠,總隨訪率達(dá)到85.90%;其中A組26例,隨訪率為86.67%;B組41例,隨訪率為85.42%。術(shù)后兩組都沒有發(fā)生手術(shù)切口感染。術(shù)中出血總量、手術(shù)操作時長、術(shù)后并發(fā)癥情況、術(shù)后下地時間均有統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后1個月,3個月,6個月Harris評分統(tǒng)計(jì)結(jié)果無顯著差異。結(jié)論:經(jīng)過統(tǒng)計(jì)軟件統(tǒng)計(jì)學(xué)分析后,術(shù)中出血總量、手術(shù)操作時長、術(shù)后并發(fā)癥情況、術(shù)后下地時間均有統(tǒng)計(jì)學(xué)意義,術(shù)后1個月,3個月,6個月Harris評分統(tǒng)計(jì)結(jié)果無顯著差異。PFNA具有手術(shù)操作時長短、術(shù)中切口較小、術(shù)中出血總量少的優(yōu)點(diǎn);人工全髖關(guān)節(jié)置換術(shù)具有術(shù)后并發(fā)癥少、下地活動時間早的優(yōu)點(diǎn),兩組資料在術(shù)后6個月隨訪中Harris評分無顯著差異,證明PFNA和THA在治療老年不穩(wěn)定型股骨粗隆間骨折時均有效。對于PFNA來說,完全可以通過微創(chuàng)實(shí)現(xiàn)創(chuàng)傷小、出血少、對患者打擊小的優(yōu)點(diǎn),可作為此類骨折首選治療方法。而患者骨質(zhì)疏松非常嚴(yán)重時,內(nèi)固定植入后穩(wěn)定性不可靠時,可考慮行THA;或者內(nèi)固定術(shù)失敗的病例,翻修手術(shù)很難獲得穩(wěn)定性時,THA可以作為一種補(bǔ)救措施;骨折的同時合并股骨頭缺血壞死或退行性骨關(guān)節(jié)炎時,THA可以同時解決骨折和原發(fā)病兩個問題。實(shí)際情況,應(yīng)根據(jù)患者的各方面進(jìn)行評估后選擇最適宜的手術(shù)方式。
[Abstract]:Objective: to study the duration of operation, the total amount of bleeding during operation, the postoperative complications, the time of postoperative floor movement, and the postoperative Harris score, etc. The clinical effects of (PFNA) and total hip replacement (THA) in the treatment of unstable intertrochanteric fractures of the femur were compared, and the indications for the treatment of unstable intertrochanteric fractures in the elderly were discussed. The relationship between the two surgical methods and the classification of femoral intertrochanteric fracture was analyzed, which provided a theoretical basis for the selection of the best operative method for unstable femoral intertrochanteric fracture in the elderly. Methods: from January 2012 to January 2016, 78 elderly patients with unstable intertrochanteric fracture of femur were treated with (PFNA) and total hip replacement, respectively. A retrospective analysis was made of 48 cases treated with (THA). There were 32 female patients and 46 male patients, aged between 67 and 89 years, with an average age of 76.54 years. According to Evans classification, there were 30 cases of type 鈪，

本文編號：2425067