不同手术方式治疗股骨粗隆间骨折的临床疗效研究

发布时间：2018-07-18 10:43

【摘要】：研究背景：股骨粗隆间骨折是中老年人的常见骨折类型，因髋关节周围血运丰富很少出现骨不连，但其解剖位置特殊，位于下肢传导力线的交界处，保守治疗易发生髋内翻畸形及长期卧床并发症，现主张积极手术治疗，通过坚强内固定，允许早期进行功能锻炼，恢复患肢功能，减少髋内翻畸形的发生。股骨粗隆间骨折的手术治疗多种多样，经历了主要有髓内固定和髓外固定两种方式。髓外固定的典型代表动力髋螺钉治疗股骨粗隆间骨折效果良好，骨折愈合率高，并发症较少。随着髓内固定的不断发展，髓内系统展现出更加优良的效果和更低的并发症。髓内固定和髓外固定在治疗股骨粗隆间骨折方面有相似之处，也存在着种种差别，各自有其自身特点。目的：观察髓内固定和髓外固定系统本身的作用机制，对比各种手术的风险及疗效指标，探讨各种手术方式治疗股骨粗隆间骨折的优缺点，对比分析其各自适用范围和注意事项，为股骨粗隆间骨折的治疗在手术方式的选择上提供理论基础，在手术操作上提供借鉴和指导。方法：回顾性分析吉林大学中日联谊医院骨科2010-2013年收治股骨粗隆间骨折患者99例，其中男性58例，女性41例，根据AO分型，A1型25例，A2型51例,A3型23例。分别选用DHS、GAMMA3、INTERTAN三种不同手术方式。其中GAMMA3组43例，男26例，女17例，A1型8例，A2型26例，A3型9。INTERTAN组26例，男14例，女12例，A1型6例，A2型12例，A3型8例。DHS组30例，男18例，女12例，A1型11例，A2型13例，A3型6例。A1.1-A2.1为稳定骨折，A2.2-A3.3为不稳定骨折。髓外固定组采用平卧体位，髓内固定组将患者固定于牵引床上，透视下闭合复位。将各组患者的年龄、性别和骨折分型进行统计学分析，没有显著性差别。三组采用相同的术前准备和麻醉方式。统计各组患者的手术时间、术中出血量、切口愈合时间、骨折愈合时间、术后髋关节功能评分、术后并发症等指标，进行数据分析，观察各组指标有无显著性差异。结果：三组患者均术后随访4-13个月，骨折均愈合，切口愈合时间髓外固定组12天，髓内固定组9天。稳定组中手术时间GAMMA3组55.4±7.5min，INTERTAN组64.5±10.2min，DHS组77.4±10.4min，各组相比P0.05，差异具有统计学意义。不稳定组手术时间GAMMA3组64.3±7.1min，，INTERTAN组77.8±6.7min，DHS组97.8±8.7min，各组相比p＜0.05，差别有统计学意义。稳定组术中出血量GAMMA3组178.9±25.7ml，INTERTAN组205.0±30.3ml，DHS组270.1±37.1ml，髓内组和髓外组对比P0.05，差异具有统计学意义，髓内组间对比无统计学意义。不稳定组术中出血量GAMMA3组209.7±34.3ml，INTERTAN组220.0±17.5ml，DHS组313.1±28.7ml，髓内组和髓外组对比p＜0.05，差异有统计学意义，髓内组间对比，p＞0.05，差别无统计学意义。术后Harris评分稳定性骨折中GAMMA3组优良率88.9％，INTERTAN组优良率90.0％，DHS组优良率78.6％，通过统计分析，P0.05，三组差异无统计学意义。在不稳定骨折中，GAMMA3组优良率85.3％，INTERTAN组优良率87.5％，DHS组优良率56.3％，经统计学分析，GAMMA3组和INTERTAN组优良率高于DHS组，有统计学意义，其两组间对比差别无统计学意义。结论：三种手术方式治疗股骨粗隆间稳定骨折效果明显，骨折均能顺利愈合，在不稳定骨折中治疗中，DHS内固定失败率高，髓内固定效果良好，GAMMA3手术时间短，适合耐受性差的患者，INTERTAN有更好的加压效果和稳定性，适合粉碎性骨折和骨质疏松患者。
[Abstract]:Background : The fracture of the femur is a common type of fracture in the middle - aged and old people . Because of the abundant blood transport around the hip joint , the fracture healing rate is high and the complication is less .

Objective : To observe the function mechanism of intramedullary fixation and extramedullary fixation system , to compare the advantages and disadvantages of various surgical methods in treatment of intertrochanter fracture of femur .

Methods : A retrospective analysis was performed in 99 cases of fracture of femur between 2010 - 2013 in JiLin University of Jilin University . Among them , 58 male and 41 female patients were treated according to AO type , type A1 in 25 cases , type A2 in 51 cases , type A2 in 12 cases , type A2 in 13 cases , type A2 in 6 cases , type A2 in 12 cases , type A2 in 13 cases , type A3 in 6 cases , type A2 in 12 cases , type A2 in 13 cases , type A3 in 6 cases , type A2 in 12 cases , type A2 in 13 cases , type A3 in 6 cases , type A2 in 12 cases , type A3 in 8 cases .

Results : All three groups were followed up for 4 - 13 months , the fracture healed , the healing time of incision healing was 12 days , and the difference was statistically significant .

Conclusion : Three kinds of operation methods can be used for the treatment of the stable fracture of the femur , and the fracture can heal smoothly . In the treatment of unstable fracture , the internal fixation failure rate of DHS is high , the intramedullary fixation effect is good , the operation time is short and the patient with poor tolerance is suitable for patients with poor tolerance , and the INTERTAN has better pressure effect and stability , and is suitable for patients with comminuted fracture and osteoporosis .
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.3

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