复位股骨矩在股骨粗隆间骨折PFNA中的应用价值

发布时间：2018-03-26 02:16

本文选题：股骨粗隆间骨折　切入点：股骨矩　出处：《大连医科大学》2015年硕士论文

【摘要】：目的:记录股骨近端抗旋髓内钉(PFNA)治疗股骨转子间骨折(IFF)患者的术后和术后6个月的X线影像学信息,通过术后及术后半年TAD值的变化程度,反应术中股骨矩的复位对股骨粗隆间骨折PFNA中螺旋刀片的影响,同时为骨外科医师提供参考数据及更深一步的研究。方法:回顾性的统计2012年至2014年大连医科大学附属二院住院并接股骨近端抗螺旋髓内钉手术治疗的患者64例,其中8例因不满足预设样本标准,予以剔除,余56例患者(61岁-89岁)均得到6-10个月的随访,查阅大连医科大学附属二院的住院记录收集相应的术中、术后及术后半年的骨折端复位情况、愈合情况、螺旋刀片的位置及顶尖距值(tip-apex distance,TAD)。将56例患者按照Baumgaetner法评估股骨距[1]的复位情况分成A(优良组)、B(差组)两组(评估股骨矩的方法包括颈干角在正位X线片上正常或轻度外翻,侧位片上形成角小于20°的角度,水平位移在正、侧位X线片上均小于4mm可被评定为定义为复位良好,反之评定为差),测量56例患者术后当时和术后半年的的TAD值,统计出两组各时期的TAD均值及均值差值,根据统计结果观察股骨矩的复位对螺旋刀片的位移有无影响。结果:56例行PFNA内固定术患者均获得6-10月随访。利用Harris髋关节评分标准测随访56例患者,结果显示髋关节功能评分优良率90.8%。本研究术后随访共出现9例力学并发症患者。A组1例,B组8例;A组1例螺旋刀片出现有向关节面穿出趋势,离关节面约3mm,半年内X线正位片移位约8mm;B组3例出现螺旋刀片明显切出趋势,正位X线片见向外上方移位,位移分别为5mm、8mm、9mm,2例出现螺旋刀片向外侧横行移位大于10mm;2例螺旋刀片有向股骨头方向穿出趋势,分别距髋关节面约3mm、4mm,半年内X线正位片移位分别为9mm、7mm;1例术后10个月出现主钉断裂现象,其术后TAD值为32mm。余45例患者骨折完全愈合,皆无切出、退钉、断钉等的严重并发症发生,患者髋关节功能恢复良好。结论:通过数据整理、归纳、统计及分析可以初步的推断出股骨矩复位的优良程度对螺旋刀片的切出率有着明显的影响。当股骨矩复位满意时,术后及术后半年的TAD差值均值为5.33mm,无螺旋刀片切出、断钉等严重并发症出现;当股骨矩复位未达到标准时,TAD差值均值显著增大,螺旋刀片半年内移位明显,平均为8.78mm,螺旋刀片发生切出趋势明显增加。
[Abstract]:Objective: to record the radiographic information of patients with intertrochanteric fracture of femur treated by proximal femur anti-rotation intramedullary nail (PFNA), and to record the degree of change of TAD value after operation and half a year after operation, and to record the radiographic information of patients with intratrochanteric fracture of femur. Effect of reduction of femoral moment during reaction on spiral blade in PFNA of intertrochanteric fracture of femur. Methods: from 2012 to 2014, 64 patients admitted to the second affiliated Hospital of Dalian Medical University and treated with proximal femoral anti-spiral intramedullary nail were analyzed retrospectively. Among them, 8 patients were excluded because they did not meet the preset sample criteria. The remaining 56 patients aged 61 to 89 were followed up for 6 to 10 months. The hospital records of the second affiliated Hospital of Dalian Medical University were collected during the operation. After operation and half a year after the fracture end reduction, healing situation, The position and tip distance of the helical blade were evaluated by Baumgaetner method. 56 patients were divided into two groups: group A (excellent group) and group B (poor group). The method of evaluating femoral moment included normal or slight vertication of neck shaft angle on orthostatic radiographs. The angle formed on the lateral film was less than 20 掳, and the horizontal displacement was less than 20 掳. The horizontal displacement was less than 20 掳on the lateral X-ray film and the horizontal displacement was less than 20 掳on the lateral X-ray film. The TAD values of 56 patients were measured at the time of operation and half a year after operation. The mean and difference of TAD in each period of the two groups were calculated. According to the statistical results, the effect of femoral moment reduction on the displacement of helical blades was observed. Results all 56 cases of PFNA internal fixation were followed up for 6-10 months. 56 cases were followed up with Harris hip score standard. The results showed that the excellent and good rate of hip joint function score was 90.8%. In this study, 9 cases of mechanical complications occurred in group A, 1 case in group A, 8 cases in group A, 1 case in group A, and 1 case in group A had a tendency to perforate the articular surface. It was about 3 mm away from the articular surface. In group B, the positive radiographs were displaced about 8 mm within half a year. In group B, the spiral blade was cut out obviously, and the positive X ray film showed outward and superior displacement. The displacement was 5mm / 8mm / 9mm respectively in 2 cases, the lateral displacement of the helical blade was greater than 10mm and 2 cases had the tendency of perforating towards the femoral head. Within half a year, the displacement of X ray positive film was 9mm / 7mm respectively. The main nail fracture occurred in 1 case 10 months after operation. The postoperative TAD value was 32mm. the remaining 45 cases were completely healed without serious complications, such as excision, denailing, nail disconnection, and so on. Conclusion: through data arrangement, induction, statistics and analysis, it can be preliminarily inferred that the excellent degree of femoral moment reduction has a significant effect on the cutting rate of the helical blade. The mean value of TAD difference was 5.33 mm after operation and half a year after operation, no serious complications such as cutting out of screw blade and broken nail appeared, the mean value of difference of TAD increased significantly when the reduction of femur moment was not up to the standard, and the displacement of screw blade was obvious within half a year. The average is 8.78 mm, the cutting out trend of the screw blade increases obviously.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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