三种内固定方法治疗股骨转子间骨折的临床疗效对比分析

发布时间：2018-01-04 16:11

本文关键词：三种内固定方法治疗股骨转子间骨折的临床疗效对比分析　出处：《郑州大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的对比三种内固定PFNA-Ⅱ(亚洲型股骨近端抗旋髓内钉)、Gamma钉、Inter TAN钉治疗股骨转子间骨折的临床效果,为以后的股骨转子间骨折的手术治疗提供相对有效的参考数据。方法回顾性分析郑大一附院骨外科自2011年11月至2015年1月手术治疗股骨转子间骨折的85例病人,女性40例,男性45例,年龄最大89岁,最小41岁,平均65.8岁,所有患者入院后均拍摄双髋标准正位片及患髋侧位片,按AO分型,A1型30例,A2型32例,A3型23例,其中采用PFNA-Ⅱ固定35例,采用Gamma钉固定22例,采用Inter TAN钉固定28例,全是单侧闭合性类型的骨折。手术后对照评估三组患者手术的时间、手术中X线透视的次数、手术中出血量、术后负重时间、术后骨折愈合时间、术后并发症、术后6个月髋关节Harris评分、术后12月髋关节Harris评分等8个维度应用统计软件进行对照分析三种髓内钉在股骨转子间骨折手术治疗的效果。结果三组的患者手术都顺利完成,均得到12-18个月的术后随访,平均随访时间为13.1个月,且无一失访。三组患者手术时间的比较:PFNA-Ⅱ组时间为52.20±12.8min,Gamma钉组时间为76.24±15.3min,Inter TAN组时间为61.23±10.05min三组患者手术时间的差异具有统计学意义(P0.05),其中用时间最短的为PFNA-Ⅱ组,其次为Inter TAN组,用时最多的是Gamma钉组;三组术中X线透视次数的比较:PFNA-Ⅱ组次数为8.60±1.1次,Gamma钉组时间为12.10±0.80次,Inter TAN组时间为8.40±0.90次,PFNA-Ⅱ组、Inter TAN组分别与Gamma钉组比较患者术中透视次数的差异具有统计学意义(P0.05),但PFNA-Ⅱ组和Inter TAN组两组相比较,患者术中透视次数无统计学差异(PO.05);三组患者术中出血量的比较:PFNA-Ⅱ组的出血量为96.80±58.40ml,Gamma钉组时间为152.30±108.60ml,Inter TAN组时间为116.23±43.55ml,三组患者术中出血量的差异具有统计学意义(P0.05),其中出血量最少的为PFNA-Ⅱ组,其次为Inter TAN组,出血量最多的是Gamma钉组;三组患者术后骨折愈合时间的比较:PFNA-Ⅱ组的愈合时间为13.40±3.10周,Gamma钉组愈合时间为14.20±3.20周,Inter TAN组时间为11.10±2.50周,PFNA-Ⅱ组、Gamma钉组分别与Inter TAN组比较患者术后骨折愈合时间的差异具有统计学意义(P0.05),Inter TAN组的愈合需要时间最短,但PFNA-Ⅱ组和Gamma钉组两组相比较,患者术后骨折愈合时间无统计学差异(PO.05);三组患者术后负重时间比较:PFNA-Ⅱ组的负重时间为41.55±22.52d,Gamma钉组负重时间为40.89±20.94d,Inter TAN组负重时间为40.15±28.04d,三组患者术后负重时间无统计学差异(PO.05);三组患者术后6个月Harris评分比较中,PFNA-Ⅱ组、Gamma钉组分别与Inter TAN组比较患者术后6个月Harris评分的差异具有统计学意义(P0.05),Inter TAN组的评分最高,但PFNA-Ⅱ组和Gamma钉组两组相比较,患者术后6个月Harris评分无统计学差异(PO.05);在术后12个月Harris评分上三者无明显的差别。三组患者术后并发症上的比较:所有被随访的患者都没有出现死亡、骨折延迟愈合、头颈短缩、髋内翻、股骨干骨折、内固定物周围骨折、内固定物失效及断裂、切口感染、切口不愈合、肺栓塞、褥疮等并发症,三组患者术后并发症发生率差异无统计学意义。结论1、在治疗股骨转子间骨折时,PFNA-Ⅱ、Gamma钉、Inter TAN钉这三种髓内钉都有较好的疗效,其中在术后下地负重时间、术后12个月Harris评分及术后并发症上三者无明显的差别,因此三种手术方式都可以尽可能的早期锻炼,缩短恢复时间,减少并发症的发生;2、PFNA-Ⅱ和其他两组相比在手术时间较短和术中出血量较少,减轻了患者的“二次打击”,尽可能减少创伤。且PFNA-Ⅱ组和Inter TAN钉组的术中透视次数少,从而大大减轻辐射对患者的危害,也对医护工作者也有了很大的保护作用;Inter TAN钉组相比其他两组的优势在术后骨折愈合时间较短和术后6个月Harris评分较高,因而早期的愈合有较大的优势。
[Abstract]:Objective to compare the three kinds of internal fixation of PFNA- (Asian proximal femoral nail anti rotation), Gamma nail, clinical effect of treatment of intertrochanteric fractures of Inter TAN nail, femur after fracture between surgical treatment and provide reference data relatively effective. Methods a retrospective analysis of the 1st Affiliated Hospital of Zhengzhou University from November 2011 to January 2015 in bone surgery surgical treatment of femoral intertrochanteric fractures in 85 patients, 40 cases were female, 45 were male, age biggest 89 years old, the minimum age of 41, with an average of 65.8 years. All patients were admitted to the hospital from hip standard anteroposterior and lateral radiographs of the hip, according to AO classification, 30 cases of type A1, 32 cases of A2 type, 23 cases of type A3, which uses PFNA- II 35 cases were fixed with Gamma nails, 22 cases were fixed with Inter and TAN nail fixation in 28 cases, all closed unilateral type fractures. Evaluation of three groups of patients with operation time after surgery, intraoperative fluoroscopy times, the amount of bleeding during operation, Postoperative weight-bearing time, fracture healing time after operation, postoperative complications, postoperative Harris hip score at 6 months, compared with three kinds of intramedullary nails in the effect of surgical treatment of intertrochanteric fractures of the femur in December Harris hip score of 8 dimensions using statistical software after surgery. Results three patients surgery successfully completed, were 12-18 months of follow-up, the mean follow-up time was 13.1 months, and no one lost. Compared three groups of patients with operation time: PFNA- group II time was 52.20 + 12.8min, Gamma nail group time was 76.24 + 15.3min, Inter TAN 61.23 + 10.05min group time difference of three groups of patients the operation time was statistically significant (P0.05), one of the shortest time for the PFNA- II group, followed by Inter TAN group, with most of the Gamma nail group; compare the X-ray fluoroscopy number of the three groups: PFNA- group II number is 8.60 + 1.1, Gamma nail group was 1 2.10 + 0.80, Inter group TAN time was 8.40 + 0.90, PFNA- II group, Inter TAN group and Gamma group compared with the difference of nail fluoroscopy during operation in patients with statistical significance (P0.05), but the PFNA- II group and Inter TAN group compared two groups of patients with intraoperative fluoroscopy times had no statistical difference (PO.05); compare the amount of bleeding in the three groups: the amount of bleeding of PFNA- group was 96.80 + 58.40ml, Gamma nail group time was 152.30 + 108.60ml, Inter of TAN group was 116.23 + 43.55ml, the difference was statistically significant amount of bleeding in the three groups (P0.05), one of the least amount of bleeding PFNA- II group, followed by Inter TAN group, the amount of bleeding is the most Gamma nail group; compare the fracture healing time of three groups of patients: PFNA- II Group healing time was 13.40 + 3.10 weeks, Gamma nail group healing time was 14.20 + 3.20 weeks, Inter TAN group time was 11.10 + 2.50 weeks. PFNA- II group, Gam Ma nail group and Inter TAN group compared with postoperative fracture healing time was statistically significant difference (P0.05), Inter TAN group healing time is short, but the PFNA- group and Gamma nail group compared the two groups, there was no significant difference in fracture healing time after surgery (PO.05); comparison of loading time of patients the three groups after surgery: PFNA- II group loading time was 41.55 + 22.52d, Gamma nail group loading time was 40.89 + 20.94d, Inter group TAN loading time was 40.15 + 28.04d, three groups of patients with postoperative weight-bearing time no statistical difference (PO.05); comparison of Harris score at 6 months after operation in the three groups, PFNA- in group II, with statistical significance Gamma nail group and Inter TAN group of patients after 6 months Harris score difference (P0.05), Inter TAN group was the highest, but the PFNA- group and Gamma nail group, compared two groups of patients after 6 months Harris score was no significant difference (P O.05); in 12 months after surgery, Harris score of three had no obvious difference. The complications between the three groups of patients with postoperative follow-up: all patients had no death, delayed fracture healing, short neck, hip varus, femoral shaft fracture, periprosthetic fracture, internal fixation failure and fracture, incision infection, incision healing, pulmonary embolism, bedsore and other complications of postoperative complications in the three groups had no statistically significant difference in the incidence rate of 1. In conclusion, the treatment of intertrochanteric fracture, PFNA- II, Gamma nail, Inter nail TAN these three kinds of intramedullary nails have good curative effect, the postoperative under the loading time, there is no significant difference between Harris scores at 12 months after surgery and postoperative complications in three, so three kinds of operation can be as much as possible early exercise, shorten recovery time, reduce the incidence of complications; 2, PFNA- II and compared to the other two groups in the operation time is Short and less bleeding, reduce the patient's "two hit", as far as possible to reduce trauma. And the perspective PFNA- II group and Inter TAN nail group intraoperative number, thus greatly reduce the radiation harm to patients, but also for medical workers also have a great protective effect; Inter TAN nail group compared to the other two groups the advantages of shorter recovery time and postoperative 6 months Harris score higher in the postoperative fracture, thus early healing has a greater advantage.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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