小切口解剖锁定加压钛板与PFNA治疗老年股骨粗隆间骨折的对比分析

发布时间：2018-05-10 08:50

本文选题：股骨粗隆间骨折 + 小切口　；参考：《遵义医学院》2017年硕士论文

【摘要】：目的:对比分析小切口解剖锁定加压钛板与PFNA手术对老年股骨粗隆间骨折的疗效差异。方法:回顾性分析我院2010.11-2014.11资料完整的102例手术治疗老年股骨粗隆间骨折的患者,其中小切口解剖锁定加压钛板手术治疗(钛板组)53例:男性16例,女性37例,平均年龄75.3岁。PFNA手术治疗(PFNA组)49例:男性18例,女性31例,平均年龄74.9岁。两组手术均由同一治疗小组完成,其中主任医师一名,副主任医师一名,主治医师一名,住院医师三名。不存在手术技巧及治疗方面的差异。统计两组患者术中X线透视次数、手术时间、术中及术后显性出血量,隐性出血量,总出血量、术后内固定失败率、术后下肢深静脉血栓形成率、住院时间、负重时间、骨折愈合时间及术后6、12、18个月Harris评分等相关数据。结果:102例患者均获得18-24个月随访,平均22.5个月。两组患者负重时间比较,PFNA组14.3±1.8d,钛板组30.4±2.6d,PFNA组时间短于钛板组,差异有统计学意义(P0.05)。两组患者在X线透视次数、隐性出血量及总出血量比较,钛板组分别为4.5±1.2次、334.6±122.6ml、519.8±142.4ml,PFNA组分别为8.9±1.4次、448.6±156.6ml、595.3±185.3ml,两组数据比较差异有统计学意义(P0.05)。两组患者在手术时间、住院时间、骨折愈合时间、术后内固定失败率、术后下肢深静脉血栓形成率比较,钛板组分别为75.8±13.2min、19.2±1.0d、85.4±10.6d、1.89%、3.77%,PFNA组分别为76.3±12.1min、18.9±1.3d、84.7±12.4d、2.04%、4.08%,两组比较无统计学差异(P0.05)。两组患者在术后6、12、18个月Harris评分,钛板组分别为78.4±7.4、84.3±4.7、87.2±4.4,PFNA组分别为77.9±9.3、85.5±7.3、87.4±3.6,两组比较无统计学差异(P0.05)。结论:对于老年股骨粗隆间骨折患者,PFNA手术治疗有下地负重时间早的优点。小切口解剖锁定加压钛板手术治疗有术中进行X线透视次数少、隐性出血量及总出血量少的优点。小切口解剖锁定加压钛板内固定是治疗老年股骨粗隆间骨折又一个较理想的术式选择。
[Abstract]:Objective: to compare and analyze the curative effect of small incision anatomic locking compression titanium plate and PFNA operation on intertrochanteric fracture of femur in elderly patients. Methods: 102 patients with intertrochanteric fracture of femur in our hospital were analyzed retrospectively. Among them, 53 cases were treated with small incision anatomic locking compression titanium plate (titanium plate group: 16 males and 37 females). The mean age was 75.3 years. The mean age of PFNA group was 74.9 years old. There were 18 males and 31 females with an average age of 74.9 years. The two groups were performed by the same treatment group, including one chief physician, one deputy chief physician, one attending physician and three resident doctors. There is no difference in surgical skill and treatment. The number of times of X-ray fluoroscopy, the time of operation, the amount of dominant bleeding during and after operation, the amount of recessive bleeding, the total amount of bleeding, the failure rate of internal fixation, the rate of thrombosis of deep vein of lower extremity, the time of hospitalization, the time of weight bearing, the rate of postoperative deep vein thrombosis were counted. Fracture healing time and Harris score at 612 and 18 months after operation. Results all 102 patients were followed up for 18-24 months with an average of 22. 5 months. The time of loading weight in PFNA group was 14.3 卤1.8 days, that in titanium plate group was 30.4 卤2.6 days longer than that in titanium plate group, the difference was statistically significant (P 0.05). The frequency of X-ray fluoroscopy, the amount of recessive bleeding and the total amount of bleeding in the two groups were 4.5 卤1.2 times, 334.6 卤122.6 ml / time, 519.8 卤142.4 ml / PFNA, 8.9 卤1.4 times, respectively, respectively. The difference between the two groups was statistically significant (P 0.05). The time of operation, the time of hospitalization, the time of fracture healing, the failure rate of internal fixation and the rate of deep vein thrombosis in the titanium plate group were 75.8 卤13.2 min and 19.2 卤1.0 d respectively, and those in the PFNA group were 76.3 卤12.1min, 84.7 卤12.4 days, 2.04d, 4.08, respectively. There was no significant difference between the two groups (P 0.05). The Harris scores of the two groups were 78.4 卤7.4 卤7.4 卤4.4 卤7.4 卤3.6 at 612 and 18 months after operation, respectively, and 77.9 卤9.3 卤9.3 卤85.5 卤7.3 卤87.4 卤3.6 in the titanium plate group, respectively. There was no significant difference between the two groups (P 0.05). Conclusion: PFNA has the advantage of early loading time for elderly patients with intertrochanteric fracture of femur. Small incision anatomic locking pressurized titanium plate has the advantages of less X-ray fluoroscopy, less recessive bleeding and less total bleeding. Small incision anatomic locking compression titanium plate fixation is an ideal choice for the treatment of senile intertrochanteric fracture.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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