PFNA和DHS治疗老年性股骨粗隆间骨折的临床疗效分析

发布时间：2018-01-23 05:54

本文关键词： 股骨粗隆间骨折 DHS PFNA 疗效　出处：《湖北中医药大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：目前我国60岁以上老年人已达人口总数的10%以上，标志着我国已经步入老年化社会，老年髋部骨折的发病率逐渐升高，其中发病人数最多的为股骨粗隆间骨折，手术治疗为临床上最为主要的治疗手段，PFNA和DHS是常见的两种手术方法，本文主要探讨以上两种手术方法临床优缺点。资料与方法:一般资料：回顾性分析湖北省中医院骨伤科及武汉大学人民人民医院骨外二科自2012年6月到2013年12月确诊的股骨粗隆间骨折患者，患者的发病年龄一般为60岁以上，总计108例，按照内固定方式不同分为两个治疗组；两组患者均采用Evan-Jensen进行骨折的分型；一组采用PFNA手术方式，总共有56例患者；男性、女性病例数分别为30、26，其中左侧31例、右侧25例，平均患病年龄为64.3岁，I~V型骨折患者病例数分别为：22、18、10、6、0；另一组照组患者采用DHS手术方式，一共有52例患者，男性和女性病例数分别为30、26，其中左侧30例、右侧22例，平均患病年龄为65.4岁；Evan-Jensen分型，其中I型有23例，，II型有19例，III有7例，IV型有4例，V型0例。治疗方法：两组患者均行拍片和CT检查确诊，了解骨折情况，收住院后两组患者均给予牵引治疗，术前完善相关检查，治疗患者内科原发疾病，患者全身情况调整至手术需求，一般骨折后3-7天行手术治疗。两组患者一般行硬脊膜外麻醉，分别采用PFNA、DHS两种手术方法，术后一般常规给予第一代头孢抗生素抗炎治疗2-3天，促进骨折愈合治疗7-14天左右，伤口常规、定期予以换药，伤口一般12天左右拆线，术后半月、一个月、三个月行X线复查并指导其功能锻炼及营养指导。结果：两组108例患者均无死亡病例，术后均获得随访，随访时间为半年。两组患者发病年龄、骨折分型等情况基本相同，无统计学意义，具有可比性。PFNA组患者平均手术出血量263±17ml，平均手术时间62.2±21.2分钟，手术切口平均长度8.52cm，平均骨折愈合时间90.2天，术中X线平均透视次数11.6次，术后Harris髋关节评分优良率87.5%；术后发生髋内翻1例，感染2例，术后总并发症发生率5.3%；而DHS组患者平均手术出血量385±25ml，平均手术时间101.6±17.3分钟，手术切口平均长度18.4cm，平均骨折愈合时间118.5天，术中X线平均透视次数5.2次，术后Harris髋关节评分优良率67.3%；术后发生髋内翻8例、内固定松动4例、感染4例、压疮6例，术后总并发症发生率42.3%。两组患者对比有明显差异性（P＜0.05），具有统计学意义。结论：骨折后的良好复位和复位后给予坚强和稳固的内固定可以使股骨粗隆间骨折早日愈合，可以减短患者因骨折而长期卧床的时间，极大降低了因卧床时间长而导致的并发症的发生。PFNA是目前临床运用逐渐增多的新型内固定装置，该内固定装置的形态和结构根据人体股骨解剖形态和力学特点而设计的是使股骨头、颈部的剪切力减小和抗旋力增强。与此同时PFNA组患者术中出血量和术后并发症要明显低于DHS治疗组患者，术后恢复情况优良率明显高于DHS组患者。故股骨粗隆间骨折一旦确诊在无明显手术禁忌症的情况下，应该早日安排手术，手术后指导患者早期进行患侧肢体的功能恢复，视恢复的情况尽可能早的让患者下床活动，这样就可以减少卧床导致的并发症，减轻患者痛苦，经两种方法比较发现PFNA治疗股骨粗隆间骨手术具有手术时间短，创伤小，固定牢靠，术后并发症少等优点更值得临床应用。
[Abstract]:Objective: to present our elderly over the age of 60 has reached 10% of the total population, indicates that China has entered the aging society, the elderly hip fracture incidence increased gradually, one of the largest number of disease for intertrochanteric fractures, surgical treatment is the main treatment is the most clinically, PFNA and DHS is the two kind of common surgical method, this paper mainly discusses the above two kinds of operative methods for clinical advantages and disadvantages.
Materials and methods: the general data: a retrospective analysis of Hubei Provincial Traditional Chinese Medical Hospital of Wuhan University and the people's Hospital of orthopedics bone outside the two from June 2012 to December 2013 diagnosed patients with femoral intertrochanteric fracture, the age of patient is generally over the age of 60, a total of 108 cases, according to the different internal fixation methods, the patients were divided into two groups; type two all patients with Evan-Jensen fractures; a group using the PFNA procedure, a total of 56 patients were male, female; the number of cases were 30,26, 31 cases in the left and right side in 25 cases, the average age was 64.3 years, the number of cases of type I~V fracture patients were 22,18,10,6,0 DHS operation; another group group of patients with a total of 52 patients, male and female cases were 30,26, 30 cases in the left and right side in 22 cases, the average age was 65.4 years; the Evan-Jensen type, I type 23 cases, There were 19 cases of type II, 7 cases of III, 4 cases of IV type and 0 cases of V type.
Treatment methods: two patients underwent X-ray and CT examinations, understanding of fracture, admitted to hospital after two groups of patients were given traction treatment, perfect preoperative examination, medical treatment of patients with primary disease, adjust the general condition of the patients to surgery, surgery is generally 3-7 days after fracture. Two groups of patients with general hard line the epidural anesthesia, respectively PFNA, DHS two kinds of operative methods, postoperative general routine first generation cephalosporin antibiotic anti-inflammatory treatment 2-3 days, 7-14 days for promoting fracture healing, wound routine, regularly wound dressing, usually about 12 days after take out stitches, half a month, three months for X-ray review and guide the functional exercise and nutrition guidance.
Results: two groups of 108 patients were no deaths, all the cases were followed up for six months. The two groups of patients age, fracture type, the situation is basically the same, no statistically significant, with comparable average surgical patients in the.PFNA group the amount of bleeding was 263 + 17ml, the average operation time was 62.2 + 21.2 minutes, the average incision length was 8.52cm, the average healing time of 90.2 days, the average intraoperative X-ray fluoroscopy times 11.6, postoperative Harris hip score good rate of 87.5%; 1 cases of postoperative hip varus occurred in 2 cases, infection, postoperative complication rate was 5.3%; while the average amount of bleeding in operation group DHS 385 + 25ml, the average operation time was 101.6 + 17.3 minutes, the average incision length was 18.4cm, the average healing time of 118.5 days, the average intraoperative X-ray fluoroscopy times 5.2, postoperative Harris hip score good rate of 67.3%; 8 cases of postoperative hip varus, internal fixation loosening in 4 cases, There were 4 cases of infection and 6 cases of pressure sore. The incidence of total complications after operation 42.3%. two groups was significantly different (P < 0.05), with statistical significance.
Conclusion: after fracture reduction and reduction after giving strong and stable fixation can make the early healing of femoral intertrochanteric fracture, which can shorten the patients because of fracture bedridden time, greatly reducing the incidence of.PFNA caused by the long bed time of complications is a new type of internal fixation for the current clinical application of gradually increasing. The morphology and structure of the internal fixation device according to the human femur anatomy and mechanical characteristics and is designed to make the femoral head, neck and enhance the shear stress decreases anti rotation force. At the same time the amount of bleeding and postoperative complications of patients in the PFNA group was significantly lower than that in DHS treated patients, postoperative recovery was significantly higher than DHS groups of patients. The femoral intertrochanteric fracture in once diagnosed no surgical contraindications, should arrange an early surgery, after surgery to guide patients with early limb function Can recovery, as the recovery situation as early as possible to allow patients to get out of bed, so it can reduce the bed causing complications, alleviate the suffering of patients, through the comparison of two methods showed that PFNA treatment of intertrochanteric bone surgery with shorter operation time, less trauma, reliable fixation, postoperative complications more worthy of clinical application.

【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.3

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