加长型PFNA和加长型第三代Gamma钉治疗股骨近端长段粉碎性骨折疗效分析

发布时间：2018-02-15 07:00

本文关键词： 加长型PFNA 加长型第三代Gamma钉股骨近端长段粉碎性骨折　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:比较加长型股骨近端防旋髓内钉(long proximal femoral nail antirotation,long PFNA)与加长型第三代Gamma钉(prolonged third gener-ation of Gamma nail,pTGN)治疗股骨近端长段粉碎性骨折(long commi-nuted fracture of proximal femoral)的临床疗效,为股骨近端长段粉碎性骨折患者内固定的选择提供参考依据。方法:回顾性研究广西医科大学第三附属医院骨科在2014年6月-2016年5月期间收治的股骨近端长段粉碎性骨折患者65例,采用long PFNA治疗的有32例,采用pTGN治疗的有33例。记录两组患者手术时间、术中出血量、术后尖顶距、住院时间、骨折愈合时间、术后并发症、髋关节Harris评分等进行对比研究。并用SPSS20.0做数据整理及统计学分析。结果:long PFNA组和pTGN组在手术时间、术中出血量分别为122.15±17.65min和 132.58±20.50min、250.44士20.99ml和280.18士 16.58ml,两组比较差异具有统计学意义(P0.05)。Singh指数≤3级的患者中,long PFNA组与pTGN组在术后6个月尖顶距分别为20.66±4.16mm和23.96± 3.56mm,两组对比其差异具有统计学意义(P0.05)。long PFNA组和pTGN组在住院天数、术后并发症、骨折愈合时间、术后6个月及术后12个月Harris评分对比,差异无统计学意义(P0.05)。结论:与pTGN相比,long PFNA治疗骨质疏松的股骨近端长段粉碎性骨折患者,能充分发挥近端螺旋刀片打压骨松质、抗旋转、抗切割等优势,操作更为简便,手术时间短,术中出血量少。而pTGN更适合于骨质较好的股骨近端长段粉碎性骨折青年患者,能充分发挥近端拉力螺钉的加压优势。long PFNA与pTGN都是治疗股骨近端长段粉碎性骨折可靠有效的内固定物,都能使患者早期行功能锻炼,促进髋关节功能恢复,术后并发症少,住院时间短,促进骨折愈合。根据患者的具体情况,合理选择内固定物是股骨近端长段粉碎性骨折手术成功的关键。
[Abstract]:Objective: to compare the clinical effects of long proximal femoral nail antirotation long PFNAs and extended third generation Gamma nailing third gener-ation of Gamma nailpTGNs in the treatment of long commi-nuted fracture of proximal femur fractures. Methods: a retrospective study of the proximal long femoral long segment powder treated in the Department of Orthopaedics of the third affiliated Hospital of Guangxi Medical University from June 2014 to May 2016 was conducted to provide a reference for the selection of internal fixation for the patients with proximal long femoral comminuted fractures. 65 patients with broken fractures, 32 cases were treated with long PFNA, 33 cases were treated with pTGN. The Harris score of hip joint was compared and analyzed with SPSS20.0. Results the operation time of PFNA group and pTGN group was compared with that of pTGN group. The intraoperative bleeding volumes were 122.15 卤17.65min and 132.58 卤20.50min, 250.44 卤20.99ml and 280.18 卤16.58ml, respectively. There was a statistically significant difference between the two groups in the peak distance between the two groups at 6 months after the operation. The difference between the two groups was 20.66 卤4.16mm and 23.96 卤3.56mm, respectively. The difference was statistically significant (P 0.05). Long PFNA group and pTGN group were in hospital days. There was no significant difference in postoperative complications, fracture healing time, Harris score between 6 months and 12 months after operation (P 0.05). Conclusion: compared with pTGN, long PFNA is used to treat patients with long proximal comminuted fracture of femur. It can give full play to the advantages of proximal helical blade, such as pressing cancellous bone, anti-rotation, anti-cutting, etc., the operation is simpler, the operation time is short, and the amount of intraoperative bleeding is less. However, pTGN is more suitable for young patients with long proximal comminuted fracture of femur. Long PFNA and pTGN are reliable and effective internal fixators in the treatment of proximal long segment comminuted fractures. Both of them can make the patients perform early functional exercise and promote the recovery of hip joint function. According to the specific conditions of the patients, reasonable selection of internal fixator is the key to successful operation of proximal long segment comminuted fracture of femur.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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