糖尿病对股骨颈骨折不同手术方法的疗效和预后的影响

发布时间：2018-06-05 03:32

本文选题：股骨颈骨折 + 糖尿病　；参考：《福建医科大学》2015年硕士论文

【摘要】：目的:了解糖尿病在股骨颈骨折的三种手术治疗方案中所产生的不同影响,为今后手术治疗合并糖尿病的股骨颈骨折患者提供临床经验。方法:本研究选取股骨颈骨折的手术患者477例为研究对象,按手术方式分为内固定组、全髋关节置换组及人工股骨头置换组,再将每个手术组分为糖尿病组和非糖尿病组两个亚组,并通过SPSS进行统计学分析疗效和预后指标。结果:内固定组及全髋关节置换组的非糖尿病患者年龄较糖尿病患者小(P0.05),但在人工股骨头置换组中两亚组差异无统计学意义(P0.05)。三种术式的糖尿病组与非糖尿病患者在性别、入院时血红蛋白、骨折部位、骨折分型、髋部骨折史差异上均无统计学意义(P0.05)。人工股骨头置换组的糖尿病患者骨密度较非糖尿病组高(P0.01)。三种术式的糖尿病组在伤后至手术时间、术后住院时间、总住院时间均较非糖尿病组长(P0.05)。在骨折前内科合并症中,三种术式的糖尿病患者合并高血压的比例较非糖尿病组高(P0.05),行关节置换术的糖尿病与非糖尿病患者在心脏病(P0.05)、脑血管疾病(P0.05)患病率上有显著差异,但行骨折内固定术的患者差异却无统计学意义(P0.05)。在围手术期并发症中,人工股骨头置换组的糖尿病患者心脏病发病率高于非糖尿病患者(P0.05)。关节置换组的糖尿病患者出现胃肠道症状的比例高于非糖尿病患者(P0.05)。三种术式的糖尿病患者在随访1年后的术后活动功能、疼痛评分及X线表现上与非糖尿病患者均无统计学差异(P0.05)。结论:相比非糖尿病患者,股骨颈骨折的糖尿病患者住院时间更长,骨折前内科合并症及围手术期并发症发病率更高,且这种差异在不同手术方案中所表现的不全相同。但糖尿病患者在术后活动功能、疼痛评分及X线表现上与非糖尿病组相比差异均无统计学意义。对于糖尿病患者,应加强围手术期血糖控制及术前内科合并症、围手术并发症的处理,缩短住院时间。
[Abstract]:Objective: to investigate the different effects of diabetes mellitus in the treatment of femoral neck fracture, and to provide clinical experience for the treatment of femoral neck fracture with diabetes in the future. Methods: 477 patients with femoral neck fracture were divided into internal fixation group, total hip replacement group and artificial femoral head replacement group. Each operation group was divided into two subgroups: diabetic group and non-diabetic group. The curative effect and prognostic index were analyzed statistically by SPSS. Results: the age of non-diabetic patients in the internal fixation group and the total hip replacement group was lower than that in the diabetic group, but there was no significant difference between the two subgroups in the artificial femoral head replacement group (P 0.05). There was no significant difference in sex, hemoglobin at admission, fracture location, fracture classification and hip fracture history between the diabetic group and the non-diabetic group (P 0.05). Bone mineral density (BMD) in the artificial femoral head replacement group was higher than that in the non-diabetic group (P 0.01). The duration from injury to operation, postoperative hospitalization time and total hospitalization time of the three types of diabetes group were all higher than that of the non-diabetic group (P 0.05). In the prefracture internal medical complications, the proportion of diabetic patients with hypertension was higher than that of non-diabetic patients. There were significant differences in the prevalence of heart disease and cerebrovascular disease between the patients with joint replacement and those with non-diabetes mellitus (P 0.05, P 0.05), and there were significant differences in the prevalence of heart disease (P 0.05) and cerebrovascular disease (P 0.05) between the patients with joint replacement and non-diabetic patients. However, there was no significant difference in patients undergoing internal fixation of fractures (P 0.05). Among the perioperative complications, the incidence of heart disease in the artificial femoral head replacement group was higher than that in the non-diabetic group (P 0.05). The incidence of gastrointestinal symptoms in joint replacement group was higher than that in non-diabetic patients (P 0.05). There was no significant difference in postoperative motor function, pain score and X-ray findings between the three types of diabetic patients and non-diabetic patients (P 0.05). Conclusion: compared with non-diabetic patients, the patients with femoral neck fractures have longer hospitalization time, higher incidence of prefracture complications and perioperative complications. However, there was no significant difference in postoperative motor function, pain score and X-ray findings between diabetic patients and non-diabetic patients. For diabetic patients, we should strengthen perioperative blood glucose control, preoperative internal complications, perioperative complications, and shorten hospital stay.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3;R587.1

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