股骨粗隆外侧壁的完整性与不稳定型股骨粗隆间骨折疗效的相关性分析

发布时间：2018-06-21 03:19

本文选题：股骨粗隆间骨折 + 疗效　；参考：《安徽医科大学》2015年硕士论文

【摘要】：目的：通过对比标准伽玛-Ⅲ型带锁髓内钉(Gamma-3)治疗外侧壁危险型及外侧壁破坏型股骨粗隆间骨折的临床疗效,研究股骨粗隆外侧壁完整性与不稳定型骨折术后疗效的关系,深入了解股骨粗隆外侧壁的临床意义。方法：按照标准选择56例2013年1月至2014年7月因不稳定型股骨粗隆间骨折于我院新区骨科行骨折闭合复位髓内钉内固定术的患者,根据骨折类型分为外侧壁危险型组及外侧壁破坏组,其中外侧壁危险型组38例,男性20例,女性18例,年龄32岁-91岁,平均70.7±1.3岁,外侧壁破坏组18例,男性11例,女性7例,年龄40岁-85岁,平均70.3±1.3岁,统计并对比两组患者年龄、性别、受伤至手术时间等指标。选择Gamma-3型髓内钉为内固定材料进行手术治疗,术后对比分析两组患者术中失血量、手术时间及术后6个月Harris评分情况。结果：56例患者术后平均随访10.6个月(6个月～12个月),3例患者(外侧壁危险组1例,外侧壁破坏组2例)术后摄片发生轻度髋内翻畸形,予延迟下地时间等处理后获得临床愈合；1例外侧壁危险组患者术后并发下肢深静脉血栓,予溶栓及人工滤网植入后症状缓解；1例外侧壁危险组患者术后2月外伤后造成股骨干骨折,另行股骨干钢板内固定术,延迟下地活动；1例外侧壁破坏组患者术后发生拉力螺钉切出,内固定失败,更换人工股骨头置换术,所有患者均恢复伤前行走功能。两组患者年龄、性别、受伤至手术时间、术中失血量及手术时间比较差异无统计学意义(P0.05),术后6个月Harris髋关节功能评分差异对比有统计学意义(P0.05),外侧壁危险组术后疗效优于外侧壁破坏组。结论：采用Gamma-3型髓内钉治疗不稳定型股骨粗隆间骨折可取得良好疗效,外侧壁完整性对于Gamma-3型髓内钉治疗不稳定型股骨粗隆间骨折术后疗效具有重要意义。
[Abstract]:Objective: to compare the clinical effects of Gamma-III type intertrochanteric fractures with locked intramedullary nail (Gamma-3) in the treatment of intertrochanteric fractures of the lateral wall of femur and the destruction of the lateral wall of femur, and to study the relationship between the integrity of the lateral wall of femur and the curative effect of unstable type fractures. To understand the clinical significance of the lateral wall of femoral trochanter. Methods: Fifty-six patients with unstable intertrochanteric femoral fractures underwent closed reduction and intramedullary nail fixation from January 2013 to July 2014 in the new area of our hospital. According to the type of fracture, the patients were divided into the lateral wall risk type group (n = 38) and the lateral wall destruction group (n = 38, male 20, female 18, age 32 to 91 years, mean 70.7 卤1.3 years), lateral wall destruction group (n = 18), male (n = 11) and female (n = 7). The age ranged from 40 to 85 years old (mean 70.3 卤1.3 years). The age, sex and time of injury to surgery were statistically compared between the two groups. Gamma-3 type intramedullary nail was selected as internal fixation material for surgical treatment. Postoperative blood loss, operative time and Harris score at 6 months after operation were compared between the two groups. Results 56 patients were followed up for an average of 10.6 months (from 6 months to 12 months), 3 patients (1 case in the lateral wall risk group and 2 cases in the lateral wall destruction group) developed mild coxa varus deformity after radiography. After the treatment of delayed subsurface time, 1 case of the side wall risk group was treated with thrombolytic therapy and artificial filter mesh implantation, and the symptoms were alleviated after operation in the side wall risk group. 1 case of lateral wall risk group caused femoral shaft fracture after 2 months of trauma, another femoral shaft plate internal fixation, 1 case of lateral wall destruction group occurred pull screw excision after operation, internal fixation failed, After replacement of artificial femoral head, all patients recovered their walking function before injury. Age, gender, time of injury to surgery, There was no significant difference in blood loss and operative time during operation (P 0.05). There was significant difference in Harris hip joint function score 6 months after operation (P 0.05). The curative effect of lateral wall risk group was better than that of lateral wall destruction group. Conclusion: Gamma-3 type intramedullary nail is effective in the treatment of unstable intertrochanteric fracture of femur. The integrity of lateral wall is of great significance for the treatment of unstable intertrochanteric fracture of femur with Gamma-3 type intramedullary nail.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【相似文献】