【摘要】：目的回顧性分析INTERTAN髓內(nèi)釘與PFNA-Ⅱ髓內(nèi)釘治療老年股骨粗隆間骨折臨床效果。方法自2010年10月至2014年8月我科收治128例老年股骨粗隆間骨折患者,骨折分型按照AO分型標(biāo)準(zhǔn)進(jìn)行分類,50例為A1型、57例為A2型及21例為A3型。69例應(yīng)用Smith㤘Nephew公司INTERTAN髓內(nèi)釘治療,59例采用Synthes公司PFNA-Ⅱ髓內(nèi)釘治療。比較兩組患者手術(shù)時(shí)間、術(shù)中出血量、切口長(zhǎng)度、術(shù)后輸血例數(shù)及輸血量、骨折愈合時(shí)間、內(nèi)固定失效例數(shù)、術(shù)后3個(gè)月大腿疼痛程度及末次隨訪髖關(guān)節(jié)功能Harris評(píng)分。兩組數(shù)據(jù)計(jì)量資料(手術(shù)時(shí)間、術(shù)中出血量、切口長(zhǎng)度、術(shù)后輸血量、骨折愈合時(shí)間)采用t檢驗(yàn),計(jì)數(shù)資料(術(shù)后輸血例數(shù)、內(nèi)固定失效例數(shù)、術(shù)后3個(gè)月大腿疼痛程度、Harris評(píng)分)采用卡方檢驗(yàn)進(jìn)行統(tǒng)計(jì)分析,結(jié)果所有患者獲得8~16個(gè)月隨訪,平均(10.33±2.75)個(gè)月。PFNA-Ⅱ組在手術(shù)時(shí)間[(50.00±7.82)min]、術(shù)中出血量[(74.00±48.35)ml]、術(shù)后輸血量[(1.60±0.70)U]較INTERTAN組少,INTERTAN組內(nèi)固定失敗6例少于PFNA-Ⅱ組失敗1例(P0.05),兩組切口長(zhǎng)度[INTERTAN組(4.00±0.94)cm、PFNA-Ⅱ組(3.80±0.79)cm]、骨折愈合時(shí)間[INTERTAN組(5.20±0.92)個(gè)月、PFNA-Ⅱ組(5.30±0.95)個(gè)月]、術(shù)后輸血例數(shù)(INTERTAN組41例、PFNA-Ⅱ組38例)、術(shù)后3個(gè)月大腿疼痛程度(INTERTAN組2例、PFNA-Ⅱ組5例)和末次隨訪髖關(guān)節(jié)功能Harris評(píng)分(INTERTAN組優(yōu)45例、良19例、可3例、差2例,PFNA-Ⅱ組優(yōu)35例、良15例、可5例、差4例)均無明顯差異(P0.05)。結(jié)論 PFNA-Ⅱ及INTERTAN均為髓內(nèi)固定,符合微創(chuàng)理念,另各具有優(yōu)勢(shì),PFNA-Ⅱ操作相對(duì)簡(jiǎn)單,適用于內(nèi)科合并癥多的老年不易長(zhǎng)時(shí)間手術(shù)者,INTERTAN實(shí)踐中更具有良好的生物力學(xué)優(yōu)勢(shì)及穩(wěn)定性,減少患者術(shù)后大腿疼痛。臨床中對(duì)于反粗隆間骨折,建議應(yīng)用加長(zhǎng)髓內(nèi)釘固定,減少局部應(yīng)力集中及再骨折風(fēng)險(xiǎn),A2.2以上不穩(wěn)定型骨折優(yōu)選INTERTAN髓內(nèi)釘,減少頭釘切割。
[Abstract]:Objective to analyze the clinical effect of INTERTAN intramedullary nail and PFNA- II intramedullary nail in the treatment of intertrochanteric fracture of femur in the elderly. Methods from October 2010 to August 2014, 128 elderly patients with intertrochanter fracture were classified according to AO classification standard. 50 cases were A1 type, 57 cases were A2 type and 21 cases were A3 type. 69 cases were treated with INTERTAN intramedullary nail of Smith?Nephew Company and 59 cases were treated with PFNA- II intramedullary nail of Synthes Company. The operation time, intraoperative blood loss, incision length, postoperative blood transfusion, fracture healing time, failure of internal fixation, thigh pain 3 months after operation and Harris score of hip joint function in the last follow-up were compared between the two groups. The data of the two groups (operation time, intraoperative blood loss, incision length, postoperative blood transfusion, fracture healing time) were analyzed by t test, counting data (postoperative blood transfusion, failure of internal fixation, degree of thigh pain 3 months after operation, Harris score). The results showed that all patients were followed up for 8 to 16 months. The mean time of operation [(50.00 鹵7.82) min], the amount of intraoperative blood loss [(74.00 鹵48.35) ml], the postoperative transfusion volume [(1.60 鹵0.70) U] were less than those in INTERTAN group, the failure of internal fixation in INTERTAN group was less than that in PFNA- 鈪，

本文編號(hào)：2502051