PFNA治疗老年股骨粗隆间骨折术后早期疗效分析

发布时间：2018-02-03 05:27

本文关键词： PFNA 老年股骨粗隆间骨折临床疗效影响因素　出处：《河北医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:股骨粗隆间骨折是临床上常见的疾病,这种疾病发病率较高,且在老年人群中比较常见,随着我国人口老龄化的不断加剧,股骨粗隆间骨折发生率出现上升趋势。患者发病后主要以疼痛、丧失下床活动能力、需要家属长期护理、导致原有心脑血管疾病加重等为特点,影响患者正常生活和工作。目前,临床上对于股骨粗隆间骨折治疗方法相对较多,常见的包括:LCP(股骨近端锁定钢板)内固定和PFNA内固定等,这些方法均能够有效的改善患者症状,提高临床疗效。但是,临床上对于不同治疗方法在老年股骨粗隆间骨折中的疗效尚存在较大的争议。同时,患者PFNA内固定手术后早期疗效的影响因素研究也相对较少。因此,临床上研究PFNA内固定治疗老年股骨粗隆间骨折术后早期疗效的影响因素具有重要的意义。方法:选取2013年09月至2014年12月在我院(冀中能源峰峰集团总医院)因股骨粗隆间骨折手术治疗的80例老年患者资料进行分析,根据采用内固定方案不同将患者分为LCP组和PFNA组,比较两组患者临床治疗后手术时间、术中出血量、住院时间以及术后愈合时间、并发症等指标,分析患者PFNA治疗老年股骨粗隆间骨折术后早期疗效的影响因素。结果:两组患者的性别、年龄、受伤原因、身高、体重以及内科合并症情况,组间差异不存在统计学意义(P0.05);PFNA组手术时间、术中出血量、住院时间以及切口长度、术后愈合时间,显著少于LCP组,差异存在统计学意义(P0.05);PFNA组4例出现并发症,并发症发生率为10%,显著低于LCP组(11例出现并发症,并发症发生率为27.5%),差异存在统计学意义;PFNA组治疗后Harris髋关节功能评分,显著高于LCP组,差异存在统计学意义(P0.05);PFNA组治疗后负重时间,显著短于LCP组,差异存在统计学意义(P0.05);采用强迫进入的方法进行回归分析,建立多元线性回归分析方程。方差分析显示F=15.621,P0.05,有统计学意义,表明髋关节功能和T值、BMI、负重时间、及是否伴有小粗隆骨折有线性关系。R方=0.652 R=0.835,表明早期髋关节功能和是否存在小粗隆骨折、T值、BMI和患者负重时间相关程度高,标准化系数中骨密度值和负重时间的绝对值最大,表明如果患者骨密度值较好,采取早期负重的方法,可以获得较高的髋关节功能评分。结论:(1)PFNA和LCP不同治疗方法在老年股骨粗隆间骨折患者中均能取得理想效果。但是和LCP相比,PFNA更具微创性,对患者创伤更小,能够更好的改善患者关节功能。(2)PFNA治疗老年股骨粗隆间骨折术后早期的髋关节功能和骨密度、负重时间、是否存在小粗隆骨折、BMI指数有密切相关性。
[Abstract]:Objective: intertrochanteric fracture of femur is a common disease in clinic. The incidence of this disease is high and it is more common in the elderly population. The incidence of intertrochanteric fracture of the femur is on the rise. The main characteristics of the patients are pain, loss of the ability to get out of bed, the need for long-term care of the family, leading to the exacerbation of the original cardiovascular and cerebrovascular diseases. At present, there are many clinical treatment methods for intertrochanteric fracture of femur, such as: LCP (proximal locking plate of femur) internal fixation and PFNA internal fixation. These methods can effectively improve the symptoms of patients and improve the clinical efficacy. However, there is still a greater controversy about the efficacy of different treatment methods in the elderly femoral intertrochanteric fractures. At the same time. There are few factors influencing the early outcome of PFNA internal fixation in patients. It is of great significance to study the factors influencing the early curative effect of PFNA internal fixation in the treatment of senile intertrochanteric fracture. Methods: from September 2013 to December 2014, we selected (. The data of 80 elderly patients with intertrochanteric fracture of femur were analyzed. The patients were divided into LCP group and PFNA group according to the internal fixation plan. The time of operation, intraoperative bleeding, hospital stay and postoperative healing time, complications were compared between the two groups. Results: sex, age, cause of injury, height, weight and complications of the two groups were analyzed. There was no significant difference between the two groups (P 0.05). The operative time, intraoperative bleeding, hospital stay and incision length in PFNA group were significantly less than those in LCP group, and the difference was statistically significant (P 0.05). Complications were found in 4 cases in PFNA group (10%), which was significantly lower than that in LCP group (11 cases). The incidence of complications was 27.5% (P < 0.05). The score of Harris hip function in PFNA group was significantly higher than that in LCP group (P 0.05). The weight bearing time after treatment in PFNA group was significantly shorter than that in LCP group, and the difference was statistically significant (P 0.05). The multiple linear regression equation was established by using forced entry method. The variance analysis showed that there was significant difference in the function of hip joint and T value in the analysis of variance. There was a linear relationship between BMI, weight loading time, and whether or not there was a small trochanter fracture. The results showed that the function of hip joint and the T value of small trochanter fracture existed in the early stage. The correlation between BMI and weight bearing time was high, and the absolute value of bone mineral density and weight bearing time was the largest in the standardized coefficient, which indicated that if the patient had better BMD value, the method of early loading should be adopted. Conclusion the different treatments of LCP and FNA can achieve good results in elderly patients with intertrochanteric fracture of femur, but compared with LCP. PFNA is more minimally invasive, less traumatic to the patients, can improve the joint function of the patients with better treatment of elderly patients with intertrochanteric fracture of hip function, bone mineral density, weight bearing time. There is a close correlation between BMI index and small trochanteric fracture.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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