不同手术方法治疗老年股骨粗隆间骨折疗效比较

发布时间：2018-03-22 01:11

本文选题：动力髋螺钉(DHS)　切入点：股骨近端抗旋髓内钉(PFNA)　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:回顾性分析股骨近端防旋髓内钉(proximalfemoralnail Anti-rotation PFNA)、动力髋螺钉(DHS)及人工关节置换在治疗老年股骨粗隆间骨折的临床疗效。以便为临床提供参考,更好的对手术方式进行选择。方法:随机抽取我院骨科2012年6月至2016年6月收治的共140例老年股骨粗隆间骨折的治疗病例。年龄63岁至91岁,平均年龄75.1岁,其中男49例,女91例。分别采用DHS、人工股骨头置换、PFNA治疗,比较PFNA、DHS和人工关节置换术这三种治疗方法的手术切口长度、手术时间、术中出血量、围手术期输血量、术后开始负重时间及术后1年的患髋关节评分(Harris评分)等指标,SPSS17.0软件被用来处理相关的数据,得出统计学处理结果。结果:按照随机数字表法随机随访140例老年股骨粗隆间骨折的患者,随访时间7~25个月,平均13.8±1.3个月。DHS组(46):切口长度10~16cm;手术时间110.4±25.4min;术中出血351±51.2ml;围手术期输血量131.5±51.2ml;术后负重时间42~94天;术后1年髋关节Harris评分:优32例,良10例,可2例,差2例,优良率91.3%。PFNA组(49):切口长度5~7cm;手术时间52.1±15.5min;术中出血211±31.4ml;围手术期输血量91.2±31.7ml;术后负重时间3~10天;术后1年髋关节Harris评分:优33例,良13例,可2例,差1例,优良率93.8%。人工关节置换组(45):切口长度12~18cm;手术时间89.2±18.9min;术中出血410±81.4ml;术后负重时间4~12天;围手术期输血量400.2±35.9ml术后1年髋关节Harris评分:优30,良12例,可2例,差1例,优良率93.3%。将以上数据进行比较及统计学分析提示:三组在切口长度及手术时间上PFNA组相对于人工股骨头置组及DHS组具有明显优势,差异均有统计学意义(P0.05)。术中出血不符合正态分布且方差不齐,因此采用非参数秩和检验,P0.05因此认为三者之间有显著性差异,两两比较后,PFNA组的出血量最少,而人工关节组的出血量最多。输血量不符合正态分布且方差不齐,采用非参数秩和检验,P0.05因此三者之间有显著性差异,两两比较,人工关节组较其他两组输血量多,DHS组与PFNA组之间输血量无明显差异。术后开始负重时间不符合正态分布且方差不齐,采用非参数秩和检验,P0.05因此三者之间有显著性差异,两两比较,DHS组较其他两组术后开始负重时间长,PFNA组与人工关节组无明显差异。结论:三种手法方式对于治疗老年股骨粗隆间骨折均能取得良好疗效。PFNA组较DHS组与人工股骨头置换组,手术切口长度、手术持续时间、术中出血量、围手术期输血量及术后开始负重时间等指标方面均占优势。因此PFNA是治疗老年股骨粗隆间骨折的理想选择。
[Abstract]:Objective: to retrospectively analyze the clinical effect of proximal femoral nail Anti-rotation (dynamic hip screw) and artificial joint replacement in the treatment of femoral intertrochanteric fracture in elderly patients. Methods: 140 cases of femoral intertrochanteric fracture were randomly selected from our orthopedic department from June 2012 to June 2016. The patients ranged from 63 to 91 years old with an average age of 75.1 years (49 males). 91 female patients were treated with DHSand artificial femoral head replacement PFNA respectively. The incision length, operative time, intraoperative blood loss and perioperative blood transfusion were compared between PFNAN DHS and artificial joint replacement. SPSS 17.0 software was used to process the relevant data. Results: 140 elderly patients with intertrochanteric fracture of femur were followed up by random digital table for 7 ~ 25 months. Mean 13.8 卤1.3 months. DHS group: incision length 1016 cm; operative time 110.4 卤25.4 min; intraoperative bleeding 351 卤51.2 ml; perioperative transfusion volume 131.5 卤51.2 ml; postoperative weight loading time 421,94 days; hip joint Harris score: excellent 32 cases, good 10 cases, fair 2 cases, poor 2 cases, 1 year after operation, the hip joint Harris score was excellent in 32 cases, good in 10 cases, fair in 2 cases, and poor in 2 cases. The excellent and good rate of 91.3%.PFNA group was as follows: incision length 52.5 cm; operative time 52.1 卤15.5min; intraoperative bleeding 211 卤31.4 ml; perioperative transfusion 91.2 卤31.7 ml; postoperative weight loading time 310 days; hip joint Harris score: excellent 33 cases, good 13 cases, fair 2 cases, poor 1 case. The excellent and good rate was 93.8.The Harris score of hip joint in the artificial joint replacement group was excellent 30, good in 12 cases, fair in 2 cases, fair in 2 cases, poor in 1 case, operative time was 89.2 卤18.9 min, intraoperative bleeding 410 卤81.4 ml, weight bearing time 412 days, perioperative transfusion volume 400.2 卤35.9ml 1 year after operation: excellent, good in 12 cases, fair in 2 cases, poor in 1 case, good in 12 cases, good in 12 cases, fair in 2 cases, and poor in 1 case. The excellent and good rate was 93.3.Compared with the above data and statistical analysis, it was concluded that the PFNA group had obvious advantages over the artificial femoral head placement group and the DHS group in incision length and operation time. The difference was statistically significant (P 0.05). The intraoperative bleeding did not accord with normal distribution and the variance was not uniform. Therefore, the nonparametric rank sum test (P0.05) was used to conclude that there was a significant difference among the three groups, and the amount of bleeding in PFNA group was the least after pairwise comparison. The amount of blood loss in artificial joint group was the most. The amount of blood transfusion did not accord with normal distribution and the variance was not uniform. Therefore, there was significant difference among the three groups by using non-parametric rank sum test (P0.05). There was no significant difference between the artificial joint group and the other two groups in the amount of blood transfusion between the DHS group and the PFNA group. The weight loading time did not accord with the normal distribution and the variance was not uniform. The nonparametric rank sum test was used to test P05 so there was significant difference among the three groups. Compared with the other two groups, there was no significant difference between the two groups. Conclusion: the treatment of intertrochanteric fracture of the femur with three manipulations can achieve good curative effect. PFNA group is more effective than DHS group in the treatment of intertrochanteric fracture of femur. PNA group is better than DHS group in the treatment of intertrochanteric fracture of femur. Artificial femoral head replacement group, The operative incision length, operative duration, intraoperative blood loss, perioperative blood transfusion and postoperative weight bearing time were all dominant. Therefore, PFNA is an ideal choice for the treatment of senile 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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