PFNA和人工股骨头置换治疗老年骨质疏松性粗隆间骨折的临床疗效对比研究

发布时间：2018-02-24 21:04

本文关键词： 股骨近端防旋髓内钉人工股骨头置换老年骨质疏松股骨粗隆间骨折　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对比研究PFNA和人工股骨头置换两种术式治疗老年骨质疏松性股骨粗隆间骨折的临床疗效,进而探讨针对老年性骨质疏松股骨粗隆间骨折患者的有效的治疗方法。方法:从2006年6月到2014年6月,荣成市人民医院骨外科共收治股骨粗隆间骨折患者240例,其中老年骨质疏松性股骨粗隆间骨折患者158例。老年骨质疏松性股骨粗隆间骨折患者中,男性66例,女性92例,年龄65岁-95岁,平均年龄74.2岁,所有患者通过X线片或者骨密度检查均可见明显骨质疏松表现,按照Singh指数,IV度以下均定性为骨质疏松症。分别采用股骨近端防旋髓内钉(PFNA组)和人工股骨头置换(AFHR组)两种方法对老年性骨质疏松性股骨粗隆间骨折患者行手术治疗。其中,PFNA组83例,男性32例,女性51例,年龄(75.36±4.86)岁;AFHR组75例,男性30例,女性45例,年龄(75.19±5.37)岁。分别从年龄、性别、受伤侧、骨折AO分型、受伤机制、ASA分级、受伤前的活动能力、随访时间等术前基本信息,切口长度、手术时间、术中出血量、透视时间、术后引流、住院日期、术后负重时间等术中、术后相关指标,刀口感染、褥疮、DVT、肺部感染、泌尿系感染、死亡等早期并发症,Harris评分等多项指标对比分析研究两种不同治疗方法的疗效。研究结果:从年龄、性别、受伤侧、骨折AO分型、受伤机制、ASA分级、受伤前的活动能力、随访时间等术前基本信息评估PFNA与人工半髋置换两种手术治疗方法,二者无统计学意义的差别,证明两组不同治疗方案数据具有可比性。在切口长度、手术时间、术中出血、术后引流等手术创伤指标评估两种治疗方案,PFNA组要优于人工股骨头置换组,二者具有统计学意义;在术中透视时间、住院时间方面,人工骨头置换组短于PFNA组,二者具有统计学意义;然而,在术后负重时间方面,人工股骨头置换组短于PFNA组,二者具有统计学意义。在刀口感染、褥疮、DVT、肺部感染、泌尿系感染、死亡等早期并发症方面,人工股骨头置换组明显优于PFNA组,二者具有统计学意义。术后一年髋关节评分-Harris评分对比,PFNA组与人工股骨头置换组二者无明显区别,不具有统计学意义。结论:人工股骨头置换术能够让患者术后早期下地活动,缩短住院时间,减少早期卧床并发症,获得满意的功能,是治疗老年骨质疏松性转子间骨折的有效方法。
[Abstract]:Objective: to compare the clinical effect of PFNA and artificial femoral head replacement in the treatment of osteoporotic intertrochanteric fracture of femur. Methods: from June 2006 to June 2014, 240 patients with intertrochanteric fracture of femur were treated in Rongcheng people's Hospital. There were 158 cases of osteoporotic intertrochanteric fracture of femur, 66 cases of male and 92 cases of female, aged from 65 to 95 years old, with an average age of 74.2 years. All the patients showed obvious osteoporosis by X-ray or bone mineral density examination. According to the Singh index below grade IV, osteoporosis was characterized as osteoporosis. The patients with senile osteoporotic femoral intertrochanteric fracture were treated with two methods: proximal femoral intramedullary nail (PFNA group) and artificial femoral head replacement (Singh group). Surgical treatment was performed in 83 cases of PFNA group. There were 32 males, 51 females, 75 patients in AFHR group (75.36 卤4.86) years old, 30 males and 45 females, aged 75.19 卤5.37 years. Preoperative basic information, incision length, operative time, intraoperative bleeding volume, fluoroscopy time, postoperative drainage, hospitalization date, postoperative weight-bearing time, postoperative index, wound infection, bedsore DVT, pulmonary infection, etc. The efficacy of two different treatment methods was compared with Harris score of early complications such as urinary tract infection and death. Results: according to age, sex, injured side, AO classification of fracture, injury mechanism, ASA grade, and so on, the patients were divided into two groups: the age, the sex, the injured side, the AO type of fracture, the mechanism of injury, and so on. The basic information of preoperative activity before injury and follow-up time were used to evaluate PFNA and prosthetic hemiarthroplasty. There was no significant difference between the two groups, which proved that the data of different treatment schemes were comparable. Evaluation of surgical trauma indexes such as operative time, intraoperative bleeding, postoperative drainage and so on, the PFNA group was superior to the artificial femoral head replacement group in terms of the time of fluoroscopy and the length of hospitalization. The artificial bone replacement group was shorter than the PFNA group, which had statistical significance, however, the artificial femoral head replacement group was shorter than the PFNA group in weight bearing time after operation. In terms of early complications such as urinary tract infection and death, the artificial femoral head replacement group was significantly better than the PFNA group, which had statistical significance. The hip joint score-Harris score was not significantly different between the PFNA group and the artificial femoral head replacement group one year after operation. Conclusion: artificial femoral head replacement can make the patients go down early after operation, shorten the hospitalization time, reduce the complications of early bed rest, and obtain satisfactory function. It is an effective method to treat senile osteoporotic intertrochanteric fracture.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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