股骨颈骨折手术方式及手术时机的临床研究

发布时间：2018-05-08 16:51

  本文选题：股骨颈骨折 + 手术方法　； 参考：《大连医科大学》2015年硕士论文

【摘要】：目的:讨论治疗股骨颈骨折采用两种不同手术方法的临床治疗效果;讨论股骨颈骨折伤后到手术不同手术时机内固定对临床效果的影响。方法:研究对象在长治医学院附属和济医院骨科(在2011年6月至2012年10月接受诊疗)选取病例,共收集到各项条件相近的移位型股骨颈骨折病例121例,来进行回顾性分析。在这些病例中内固定治疗的病例共有86例,而全髋关节置换的病例共有35例,按不同手术方式进行手术情况(手术时间、术中出血量)、并发症(伤口感染、肺部感染、患侧深静脉血栓)和关节Harris评分(疼痛、功能、活动范围)比较。在86例内固定病例中,按手术距离受伤时间(以24小时为标准)再分组,非急诊手术组(45例)为手术距离受伤时间≥24 h的患者,而受伤到手术的时间≤24 h的患者作为急诊手术组(41例)。内固定患者均行闭合复位内固定手术治疗。180天后对这86名患者进行观察,指标包括发生并发症情况、关节功能评价、X线提示的骨折愈合情况。并且在86例内固定手术患者非急诊手术组(受伤到手术的时间≥24 h)与急诊手术组(受伤到手术的时间≤24 h)进行骨折愈合,关节Harris评分、并发症的比较。结果:1不同手术方式比较:全髋组术中出血量及手术时间明显高于内固定组(P0.01)。2不同手术方式关节功能比较:内固定组较全髋组关节功能差(P0.05)。3不同手术方式比较:内固定组较全髋组并发症发生率高(P0.01)。4相同手术方式(内固定)不同手术时机的比较:(1)X线提示的骨折愈合率:急诊手术组较非急诊手术组高(P0.05)。(2)对于内固定患者,急诊手术组髋关节功能明显高于非急诊手术组(P0.05)。(3)并发症发生率:急诊手术组较非急诊手术组发生率低(P0.05)。结论与内固定手术治疗股骨颈骨折相比,全髋关节置换具有并发症少、关节功能优的特点,但同时巨有手术创伤大,围手术期手术风险高的特点;若选择内固定手术,为降低并发症,提高治疗的总效果,尽量在伤后24 h内进行手术治疗。
[Abstract]:Objective: to discuss the clinical effect of two different surgical methods in the treatment of femoral neck fracture, and discuss the influence of internal fixation after fracture of femoral neck to different operative time. Methods: 121 cases of displaced femoral neck fractures were collected from orthopaedics department of Heji Hospital affiliated to Changzhi Medical College from June 2011 to October 2012 for retrospective analysis. Of these cases, 86 were treated with internal fixation and 35 with total hip replacement, according to different surgical procedures (operative time, intraoperative bleeding, complications (wound infection, pulmonary infection), The Harris score (pain, function, and range of movement) of the affected deep vein thrombosis was compared with that of the joint. Among 86 cases of internal fixation, 45 cases of non-emergency operation group were divided into two groups according to the time of operation distance injury (according to the standard of 24 hours), and 45 cases of non-emergency operation group were patients with the injury time of operation distance 鈮，

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