PFNA和ALP治疗老年股骨转子间骨折疗效的比较性研究

发布时间：2018-03-23 10:21

本文选题：髓内钉　切入点：锁定钢板　出处：《河北医科大学》2015年硕士论文

【摘要】：目的:比较股骨近端防旋转髓内钉(proximal femoral nail antirotation PFNA)和股骨近端解剖型锁定钢板(anatomic proximal femoral locking plate ALP)治疗老年股骨转子间骨折的疗效。方法:回顾性搜集保定市骨科医院及河北大学附属医院2011年1月至2014年1月期间通过PFNA和ALP两种手术方式治疗老年股骨转子间骨折患者71例,其中得到完整随访病例42例,其中PFNA组22例(男:12例;女:10例);ALP组20例(男:12例;女:8例)。所有病例骨折类型按AO/OTA分型,其中PFNA组稳定型10例,不稳定型骨折12例;ALP组稳定型10例,不稳定型10例。详细记录两组患者手术时间、手术切口长度、术中失血量、术后患肢负重时间、术后独立行走时间、术后并发症、住院时间、住院期间输血量、骨折愈合时间,并且在术后1个月、3个月、6个月、12个月时对两组患者进行日常生活活动(ADL)评分和Harris髋关节功能评分。最后应用统计学软件进行数据的处理,对两种手术方式的效果进行比较。结果:本组71例患者,中间因各种原因失访29例,最后42例获得完整随访,随访时间12-36个月,平均24.5个月。所有数据应用SPSS19.0软件进行统计学分析:(1)术前及术中情况比较:两组病例在年龄、性别、骨折类型及Singh指数方面比较无统计学差异(P0.05),两组资料有可比性。两组患者手术时间、切口长度、术中出血量比较有显著性差异,均有统计学意义(P0.05);住院时间比较差异无统计学意义(P0.05)。(2)术后情况比较:两组患者术后患肢负重时间、术后独立行走时间、骨折愈合时间比较有统计学差异(P0.05);住院期间输血量比较无统计学差异(P0.05)。(3)术后两组患者髋关节功能情况(Harris评分)比较:受伤前两组患者Harris评分比较无统计学差异(P0.05);术后1月、3月较受伤前差值比较有统计学差异(P0.05);术后6月、12个月较受伤前差值比较无统计学差异(P0.05);(4)术后两组患者日常生活情况(ADL评分)比较:受伤前两组患者ADL评分比较无统计学差异(P0.05);术后1月、3月较受伤前差值比较有统计学差异(P0.05);术后6月、12个月较受伤前差值比较无统计学差异(P0.05)。(5)术后髋关节Harris评分优良率比较:两组患者术后1个月、3个月Harris评分优良率比较有统计学差异(P0.05)。术后6个月、12个月Harris评分优良率比较无统计学差异(P0.05)。(6)术后并发症比较:PFNA和ALP组髋内翻和内固定松动的发生率有统计学差异(P0.05),其他术后并发症发生率比较无统计学差异(P0.05),两组术后并发症总发生率比较有统计学差异(P0.05)。结论:1 PFNA和ALP都是老年股骨转子间骨折的有效治疗方法,其在住院时间、住院期间输血量及术后6月、12个月的Harris评分比较中并无显著差异。2 PFNA与ALP比较,具有创伤小、手术时间短、术中出血少,且操作简单、固定可靠,能使病人早期下地负重及功能锻炼。3 PFNA治疗股骨转子间骨折短期疗效好于ALP,ALP并发症高于PFNA,但中长期疗效无差别。
[Abstract]:Objective: to compare the effects of proximal femoral nail antirotation PFNA) and anatomic proximal femoral locking plate ALPNA) in the treatment of femoral intertrochanteric fractures in elderly patients. From January 2011 to January 2014, 71 elderly patients with intertrochanteric fracture of femur were treated by PFNA and ALP. Among them, 42 cases were followed up completely, including 22 cases in PFNA group (12 cases in male), 20 cases in group of 10 women in PFNA group (12 cases in male) and 8 cases in female group. All fracture types were classified according to AO/OTA classification, including 10 cases of stable type in PFNA group. There were 10 cases of stable type and 10 cases of unstable type in 12 cases of unstable fracture of ALP group. The operation time, the length of incision, the amount of blood lost during operation, the time of bearing weight of affected limb, the time of walking independently after operation, the postoperative complications were recorded in detail. Length of stay, amount of blood transfusion during hospitalization, time of fracture healing, At 1 month, 3 months, 6 months and 12 months after operation, the patients in the two groups were evaluated with ADL) and Harris hip function score. Finally, the data were processed by statistical software. Results: among the 71 patients, 29 cases were lost for various reasons, and 42 cases were followed up for 12-36 months. Mean 24.5 months. All data were statistically analyzed by SPSS19.0 software. (1) preoperative and intraoperative data were compared: age, sex, sex, There was no significant difference in fracture type and Singh index between the two groups (P 0.05). There were significant differences in operation time, incision length and intraoperative bleeding between the two groups. There was no significant difference in hospitalization time between the two groups (P 0.05, P 0.05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05). There was significant difference in fracture healing time (P 0.05); there was no significant difference in blood transfusion volume during hospitalization. (P 0.05) after operation, there was no significant difference in Harris score between the two groups (P 0.05). 1 month, 3 months after the injury compared with the pre-injury difference was statistically significant (P 0.05); 6 months after the operation, 12 months compared with the injury before the difference was not statistically significant (P0. 05 / 4) after the two groups of patients daily life and ADL scores) comparison: before the injury in the two groups of patients with ADL. There was no significant difference in score (P 0.05); there was significant difference in Harris score between 1 month and 3 months after operation compared with that before injury (P 0.05); in 6 months after operation, there was no significant difference in difference between 12 months and before injury (P 0.05); the excellent and good rate of hip joint Harris score in the two groups was higher than that in the control group. There was significant difference in the excellent and good rate of Harris score at 1 month and 3 months after operation. There was no significant difference in the excellent and good rate of Harris score at 6 months and 12 months after operation. There was significant difference in birth rate (P 0.05), but there was no significant difference in the incidence of other postoperative complications (P 0.05). There was a significant difference in the total incidence of postoperative complications between the two groups. Conclusion both PFNA and ALP are effective methods for the treatment of femoral intertrochanteric fractures in the elderly. There was no significant difference in the duration of hospitalization, the amount of blood transfusion during hospitalization and the Harris score of 6 months and 12 months after operation. There was no significant difference between the two groups. They had less trauma, shorter operative time, less intraoperative bleeding, simple operation and reliable fixation. The short term effect of 3. 3 PFNA in the treatment of femoral intertrochanteric fracture was better than that of ALP, but there was no difference in the medium and long term effect.
【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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