【摘要】：目的:對(duì)比研究股骨近端防旋髓內(nèi)釘InterTAN釘與股骨近端防旋髓內(nèi)釘PFNA,在高齡股骨轉(zhuǎn)子間骨折中的臨床療效及手術(shù)技巧。方法:本實(shí)驗(yàn)研究了自2014年12月至2016年12月,在我科進(jìn)行救治的高齡股骨轉(zhuǎn)子間骨折患者,共48例。將患者分為兩組,用這兩種不同的固定方式分別進(jìn)行治療,對(duì)比分析這兩種不同手術(shù)方式療效。其中InterTAN釘組23例;PFNA組25例。采用InterTAN釘與PFNA這兩種手術(shù)方式對(duì)患者進(jìn)行治療。術(shù)前術(shù)后給予相同治療手段。對(duì)比兩組患者之間的一般資料,如傷后至手術(shù)間隔時(shí)間、手術(shù)時(shí)間、術(shù)中出血量、住院時(shí)間、愈合時(shí)間及髖關(guān)節(jié)評(píng)分等之間的差異�；颊叱鲈汉蟮�1、3、6、9、12月于門診隨訪,常規(guī)給予髖關(guān)節(jié)正側(cè)位X片,觀察骨折愈合情況,通過髖關(guān)節(jié)Harris功能評(píng)分對(duì)患者髖關(guān)節(jié)功能進(jìn)行評(píng)估,從而評(píng)價(jià)手術(shù)療效。結(jié)果:48例患者均獲隨訪評(píng)估。InterTAN釘組手術(shù)時(shí)間80~185min,平均128.7min;術(shù)中出血量110~180ml,平均140ml。PFNA組手術(shù)時(shí)間40~120min,平均68.4min;術(shù)中出血量50~110ml,平均83.6ml。術(shù)后并發(fā)癥Inter TAN釘組呼吸系統(tǒng)感染者1例、下肢血栓形成者1例、髖內(nèi)翻畸形者1例、髖部疼痛者2例;PFNA組呼吸系統(tǒng)感染1例、髖關(guān)節(jié)內(nèi)翻畸形2例、髖關(guān)節(jié)疼痛3例。無傷口紅腫感染及膿液滲出、內(nèi)置物切出股骨頸及內(nèi)置物斷裂等并發(fā)癥,骨折全部愈合。術(shù)后9個(gè)月,根據(jù)髖關(guān)節(jié)Harries功能評(píng)分標(biāo)準(zhǔn),InterTAN釘組優(yōu)12例,良8例,可2例,差1例,優(yōu)良率為87%;PFNA組優(yōu)13例,良9例,可1例,差2例,優(yōu)良率為88%。結(jié)論:InterTAN釘與PFNA這兩種手術(shù)方式對(duì)高齡股骨粗隆區(qū)骨折患者治療均有良好的治療效果,其中PFNA在手術(shù)時(shí)間和術(shù)中出血量方面更有優(yōu)勢(shì)。
[Abstract]:Objective: to compare the clinical efficacy and surgical skills of InterTAN nail and PFNA, nail in the treatment of intertrochanter fracture in the elderly. Methods: from December 2014 to December 2016, 48 elderly patients with intertrochanter fracture were treated in our department. The patients were divided into two groups and treated with these two different fixation methods, and the curative effects of these two different surgical methods were compared and analyzed. There were 23 cases in InterTAN nail group and 25 cases in PFNA group. InterTAN nail and PFNA were used to treat the patients. The same treatment was given before and after operation. The general data between the two groups, such as the interval from injury to operation, the time of operation, the amount of intraoperative bleeding, the time of hospitalization, the time of healing and the score of hip joint, were compared. The patients were followed up at 1, 3, 6, 9 and 12 months after discharge. X-rays of the hip joint were given regularly to observe the fracture healing. The hip joint function was evaluated by the hip joint Harris function score, so as to evaluate the curative effect of the operation. Results: all the 48 patients were followed up and evaluated. The operation time was 80 脳 185 min (mean 128.7 min), the intraoperative blood loss was 110 min / 180 ml, the average operation time was 40 min / 120 min (mean 68.4 min), and the intraoperative blood loss was 50 min / 110 ml (mean 83.6 ml). There were 1 case of respiratory infection, 1 case of lower extremity thrombosis, 1 case of hip varus deformity and 2 cases of hip pain in Inter TAN nail group, and 1 case of respiratory infection, 2 cases of hip varus deformity and 3 cases of hip pain in PFNA group. There were no complications such as wound redness, swelling infection and pus exudation, and the fracture healed completely. According to the Harries function score of hip joint, 12 cases were excellent, 8 cases were good, 2 cases were fair and 1 case was poor 9 months after operation. The excellent and good rate was 87% in 13 cases, good in 9 cases, fair in 1 case, poor in 2 cases, and the excellent and good rate was 88%. Conclusion: InterTAN nail and PFNA have good therapeutic effect on elderly patients with trochanter fracture, among which PFNA has more advantages in terms of operation time and intraoperative blood loss.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【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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