不同治療方式在老年股骨粗隆間骨折中的對照研究
發(fā)布時(shí)間：2019-05-25 02:27
【摘要】：背景股骨粗隆間骨折(Intertrochanteric Fracture of Femur, IFF)為臨床骨科常見病,近年來該病發(fā)病率呈上升趨勢,據(jù)統(tǒng)計(jì)其約占全身肢骨折的3.57%,占四肢骨折的25%。股骨粗隆部血運(yùn)豐富,在發(fā)生骨折后,如處理得當(dāng),患者極少出現(xiàn)不愈合現(xiàn)象。但由于粗隆間骨折一般極不穩(wěn)定,加之患者的平均年齡較高,多合并高血壓、糖尿病以及其他慢性疾病,身體條件較差,為臨床治療帶來一定難度。股骨粗隆間骨折多見于老年患者,近年來由于老齡化速度的加快,該病的發(fā)病人數(shù)呈上升趨勢。目前,臨床對于老年股骨粗隆間骨折可采取保守治療和手術(shù)治療兩種方式,保守治療由于未能對骨折端進(jìn)行有效固定,患者需較長時(shí)間臥床,易發(fā)生深靜脈血栓、泌尿道感染、肺部感染以及褥瘡等并發(fā)癥,處理較為棘手。手術(shù)治療是目前臨床常用的治療手段,主要有人工股骨頭置換、外固定、股骨近端鎖定鋼板(the locking compress plate, LCP)、動(dòng)力髖螺釘(dynamic hip screw, DHS)以及髓內(nèi)固定[股骨近端髓內(nèi)釘(proximal femoral nail, PFN)/防旋股骨近端髓內(nèi)釘(Proximal Femoral Nail Antirotation, PFNA)、Gamma釘]等方式,但目前對于上述常見手術(shù)方式的臨床療效研究較少。目的探討比較不同治療方式在老年股骨粗隆間骨折患者中的治療效果以及并發(fā)癥發(fā)生情況之間的差異,以期為臨床治療方式的選擇提供相關(guān)參考。方法分析2010年1月-2012年10月收住我院的105例老年股骨粗隆間骨折患者的臨床資料,患者均行手術(shù)治療,其中外固定架23例、防旋股骨近端髓內(nèi)釘(Proximal Femoral Nail Antirotation, PFNA)28例、動(dòng)力髖螺釘(dynamic hip screw, DHS)26例、股骨近端鎖定加壓鋼板(the locking compress plate, LCP)28例。術(shù)后隨訪12個(gè)月,參照Harries評(píng)分對各種治療方式的臨床效果進(jìn)行分析,并進(jìn)一步結(jié)合手術(shù)時(shí)間、切口長度、術(shù)中出血量、術(shù)后引流量以及術(shù)后并發(fā)癥發(fā)生情況等指標(biāo)對各手術(shù)治療方式進(jìn)行比較分析。結(jié)果105例患者骨折全部愈合,住院及隨訪期間無死亡。各項(xiàng)指標(biāo)比較：各組切口長度、手術(shù)時(shí)間、術(shù)中出血、術(shù)后引流以及臥床時(shí)間均具有顯著差異(F=18.34,22.16,23.62,26.76,24.72,P0.05)。兩兩比較發(fā)現(xiàn),切口長度：PFNA組優(yōu)于DHS組和LCP組(P0.05),但較外固定架組長(P0.05);手術(shù)時(shí)間：外固定架組優(yōu)于DHS和LCP(P0.05),但較PFNA長((P0.05);術(shù)中出血和術(shù)后引流：PFNA組和外固定架組無顯著差異(P0.05),但均優(yōu)于DHS組和LCP組；臥床時(shí)間：PFNA組、DHS組和LCP組無顯著差異(P0.05),但均優(yōu)于外固定架組。術(shù)后隨訪12個(gè)月,參照Harries評(píng)分對各組患者治療效果進(jìn)行評(píng)價(jià),其中DHS組和LCP組優(yōu)良率高于外固定架組(P0.05),但低于PFNA組(P0.05)。在對各組治療后并發(fā)癥發(fā)生情況進(jìn)行觀察發(fā)現(xiàn),PFNA組并發(fā)癥發(fā)生率優(yōu)于外固定架組、DHS組和LCP組(P0.05);外固定架組、DHS組和LCP組并發(fā)癥發(fā)生率無顯著差異(P0.05)。結(jié)論綜合考慮手術(shù)療效、手術(shù)風(fēng)險(xiǎn)以及圍手術(shù)期并發(fā)癥等多方面因素,PFNA具有創(chuàng)傷相對較小、術(shù)后療效較好、并發(fā)癥較少等優(yōu)點(diǎn),是治療老年股骨粗隆間骨折的有效’術(shù)式。
[Abstract]:Background Femoral intertrochanteric fracture (IFF) is a common disease in the clinical orthopedics. In recent years, the incidence of this disease is on the rise. According to statistics, it accounts for 3.57% of the total body limb fracture, accounting for 25% of the fracture of the limbs. The femoral rough part is rich in blood, and after the fracture, if the treatment is proper, the patient has little non-union phenomenon. However, due to the general instability of the intertrochanteric fracture, combined with the high average age of the patient, the combination of hypertension, diabetes and other chronic diseases, the condition of the body is poor, which brings some difficulty to the clinical treatment. The intertrochanteric fracture of the femur is mostly seen in the elderly. In recent years, the incidence of the disease is on the rise due to the speed of aging. At present, the clinic has the advantages of conservative treatment and operation treatment for the old intertrochanteric fracture of the femur, and the conservative treatment can not be effectively fixed on the fracture end, the patient needs to be in bed for a long time, and the complications such as deep vein thrombosis, urinary tract infection, lung infection and bedsore are easy to occur, It's more difficult to deal with. Surgical treatment is one of the most commonly used treatment methods, mainly including artificial femoral head replacement, external fixation, locking compression plate (LCP), dynamic hip screw (DHS), and intramedullary fixation (proximal femoral nail). PFN)/ anti-rotation femoral proximal nail (PFNA), Gamma nail], etc., but there are few clinical efficacy studies for the above-described common surgical methods. Objective To study the treatment effect of different treatment methods in the elderly patients with intertrochanteric fracture and the occurrence of complications, with a view to providing relevant reference for the choice of clinical treatment. Methods The clinical data of 105 old intertrochanteric fractures of femur in our hospital from January 2010 to October 2012 were analyzed, and the patients were treated with operation. Among them,23 cases of external fixation,23 cases of anti-rotation femoral nail (PFNA),28 cases of dynamic hip screw (DHS) and 26 cases of dynamic hip screw (DHS) were analyzed. The proximal locking compression plate (LCP) was used in 28 cases. The clinical effect of various treatment methods was analyzed with reference to the harries score for 12 months, and the operation treatment methods were compared with the operation time, the length of the incision, the intraoperative blood loss, the postoperative drainage flow and the occurrence of postoperative complications. Results All 105 patients had full union, no death during hospitalization and follow-up. The results showed that the length of incision, time of operation, intraoperative bleeding, postoperative drainage and bed time were significantly different (F = 18.34, 22.16, 23.62, 26.76, 24.72, P0.05). The results showed that the length of incision: PFNA group was superior to that of the DHS group and the LCP group (P0.05), but the group leader of the external fixation frame (P0.05); the operation time: the external fixator group was superior to the DHS and the LCP (P0.05), but the PFNA was longer (P <0.05); there was no significant difference between the PFNA group and the external fixation group (P0.05). However, there was no significant difference between the group of the DHS group and the LCP group (P0.05), but it was better than that of the external fixation group. The treatment effect of the group was evaluated with reference to the harries score for 12 months, and the excellent and good rate of the DHS group and the LCP group was higher than that of the external fixation group (P0.05), but lower than that of the PFNA group (P0.05). The incidence of complications in the PFNA group was superior to that of the external fixator group, the DHS group and the LCP group (P0.05). The complication rate of the external fixation frame group, the DHS group and the LCP group was not significantly different (P0.05). Conclusion PFNA has the advantages of relatively small trauma, better postoperative curative effect and less complications, and is an effective method to treat the intertrochanteric fracture of the old femur.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
本文編號(hào)：2485411
[Abstract]:Background Femoral intertrochanteric fracture (IFF) is a common disease in the clinical orthopedics. In recent years, the incidence of this disease is on the rise. According to statistics, it accounts for 3.57% of the total body limb fracture, accounting for 25% of the fracture of the limbs. The femoral rough part is rich in blood, and after the fracture, if the treatment is proper, the patient has little non-union phenomenon. However, due to the general instability of the intertrochanteric fracture, combined with the high average age of the patient, the combination of hypertension, diabetes and other chronic diseases, the condition of the body is poor, which brings some difficulty to the clinical treatment. The intertrochanteric fracture of the femur is mostly seen in the elderly. In recent years, the incidence of the disease is on the rise due to the speed of aging. At present, the clinic has the advantages of conservative treatment and operation treatment for the old intertrochanteric fracture of the femur, and the conservative treatment can not be effectively fixed on the fracture end, the patient needs to be in bed for a long time, and the complications such as deep vein thrombosis, urinary tract infection, lung infection and bedsore are easy to occur, It's more difficult to deal with. Surgical treatment is one of the most commonly used treatment methods, mainly including artificial femoral head replacement, external fixation, locking compression plate (LCP), dynamic hip screw (DHS), and intramedullary fixation (proximal femoral nail). PFN)/ anti-rotation femoral proximal nail (PFNA), Gamma nail], etc., but there are few clinical efficacy studies for the above-described common surgical methods. Objective To study the treatment effect of different treatment methods in the elderly patients with intertrochanteric fracture and the occurrence of complications, with a view to providing relevant reference for the choice of clinical treatment. Methods The clinical data of 105 old intertrochanteric fractures of femur in our hospital from January 2010 to October 2012 were analyzed, and the patients were treated with operation. Among them,23 cases of external fixation,23 cases of anti-rotation femoral nail (PFNA),28 cases of dynamic hip screw (DHS) and 26 cases of dynamic hip screw (DHS) were analyzed. The proximal locking compression plate (LCP) was used in 28 cases. The clinical effect of various treatment methods was analyzed with reference to the harries score for 12 months, and the operation treatment methods were compared with the operation time, the length of the incision, the intraoperative blood loss, the postoperative drainage flow and the occurrence of postoperative complications. Results All 105 patients had full union, no death during hospitalization and follow-up. The results showed that the length of incision, time of operation, intraoperative bleeding, postoperative drainage and bed time were significantly different (F = 18.34, 22.16, 23.62, 26.76, 24.72, P0.05). The results showed that the length of incision: PFNA group was superior to that of the DHS group and the LCP group (P0.05), but the group leader of the external fixation frame (P0.05); the operation time: the external fixator group was superior to the DHS and the LCP (P0.05), but the PFNA was longer (P <0.05); there was no significant difference between the PFNA group and the external fixation group (P0.05). However, there was no significant difference between the group of the DHS group and the LCP group (P0.05), but it was better than that of the external fixation group. The treatment effect of the group was evaluated with reference to the harries score for 12 months, and the excellent and good rate of the DHS group and the LCP group was higher than that of the external fixation group (P0.05), but lower than that of the PFNA group (P0.05). The incidence of complications in the PFNA group was superior to that of the external fixator group, the DHS group and the LCP group (P0.05). The complication rate of the external fixation frame group, the DHS group and the LCP group was not significantly different (P0.05). Conclusion PFNA has the advantages of relatively small trauma, better postoperative curative effect and less complications, and is an effective method to treat the intertrochanteric fracture of the old femur.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
【參考文獻(xiàn)】
相關(guān)期刊論文 前3條
1 張明輝;;人工股骨頭置換術(shù)治療高齡股骨粗隆間粉碎性骨折[J];實(shí)用全科醫(yī)學(xué);2006年05期
2 Barbara Brodziak-Dopiera?a;Jerzy Kwapuliński;Krzysztof Sobczyk;Danuta Wiechu?a;;Chromium Content in the Human Hip Joint Tissues[J];Biomedical and Environmental Sciences;2015年02期
3 周毅;李興海;陳玉樓;張心宇;;動(dòng)力髁螺釘治療不穩(wěn)定型股骨粗隆間骨折[J];中國矯形外科雜志;2006年22期
，本文編號(hào)：2485411
本文鏈接：http://sikaile.net/yixuelunwen/waikelunwen/2485411.html
最近更新
教材專著
