FHR和PFNA治疗老年外侧壁非完整型股骨粗隆间骨折的早期疗效比较

发布时间：2018-03-04 09:28

本文选题：股骨粗隆间骨折　切入点：髋关节置换　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景股骨粗隆间骨折系中老年骨质疏松患者常见骨折之一,约占成人骨折的3.1%,其中约65%为不稳定型[1]。对患者的健康产生严重的威胁,若不及时诊治,患者的死亡率升高。此类骨折手术治疗方式有很多,目前较为流行的有股骨近端防旋髓内钉内固定和半髋关节置换。选择何种术式更优成为临床工作中的一个重要问题。国内外学者对上述2种术式均进行大量研究,然而对外侧壁非完整型股骨粗隆间骨折治疗方案的选择的研究较少。研究目的对比分析半髋关节置换(FHR)与股骨近端防旋髓内钉(PFNA)内固定治疗老年骨质疏松性外侧壁非完整型股骨粗隆间骨折的早期疗效。了解两种治疗方式的临床疗效及特点,探讨何者更适合此类患者,为临床工作中股骨粗隆间骨折的治疗方案的选择提供依据。研究方法选择2014年1月至2016年4月安徽医科大学第三附属医院收治的64例老年骨质疏松性外侧壁非完整型股骨粗隆间骨折患者,行半髋关节置换的患者27例,设为FHR组;行股骨近端防旋髓内钉内固定的患者37例,设为PFNA组。比较两组患者的手术时间、术中出血量、切口长度、术后负重时间、住院时间及术后2周、1个月、3个月、6个月髋关节Harris评分。结果64例患者均获6~12个月随访,与PFNA组相比,FHR组患者术后负重时间、住院时间短,术后2周、1个月、3个月、6个月髋关节Harris评分高,但FHR组切口长度和手术时间较PFNA组长,差异有统计学意义(P0.05);FHR组术中出血量多于PFNA组,差异有统计学意义(P0.05)。结论FHR和PFNA治疗老年骨质疏松性外侧壁非完整型股骨粗隆间骨折早期疗效可靠,但FHR术后可更早、更快恢复髋关节功能。
[Abstract]:Background Intertrochanteric fracture of femur is one of the most common fractures in middle-aged and aged patients with osteoporosis, accounting for 3.1% of adult fractures, of which about 65% are unstable type [1]. The mortality rate is increasing. There are a lot of surgical treatments for this kind of fracture. At present, there are more popular internal fixation of the proximal femur anti-rotation intramedullary nail and the replacement of the half-hip joint. It is an important problem in the clinical work to choose the better operation method. Many scholars at home and abroad have done a lot of research on the above two methods. However, there are few studies on the treatment of non-complete femoral intertrochanteric fractures. Objective to compare and analyze the internal fixation of hemihip replacement (FHR) and proximal femoral intramedullary intramedullary nail (PFNA) in the treatment of senile patients with lateral osteoporosis. The early curative effect of nonintact femoral intertrochanteric fracture. To explore which is more suitable for such patients, To provide the basis for the treatment of intertrochanteric fracture of femur in clinical work. Methods 64 cases of senile osteoporotic lateral wall were selected from January 2014 to April 2016 in the third affiliated Hospital of Anhui Medical University. Patients with intertrochanteric fracture of femur, Twenty-seven patients with hemihip replacement were divided into FHR group and 37 patients with intramedullary nail fixation at the proximal end of femur were divided into PFNA group. The operation time, intraoperative bleeding volume, incision length, weight bearing time after operation were compared between the two groups. Results all 64 patients were followed up for 6 ~ 12 months. Compared with the PFNA group, the postoperative weight bearing time and hospitalization time were shorter than those in the PFNA group. The Harris score of hip joint in FHR group was higher than that in PFNA group at 2 weeks, 1 month, 3 months and 6 months postoperatively, but the incision length and operation time in FHR group were significantly higher than those in PFNA group, and the amount of intraoperative bleeding in FHR group was higher than that in PFNA group. Conclusion FHR and PFNA are effective in the treatment of nonintact intertrochanteric fracture of femur in elderly patients with osteoporosis, but the function of hip joint can be recovered earlier and faster after FHR.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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