防旋型股骨近端髓内钉（PFNA-Ⅱ）置入与人工髋关节置换治疗高龄转子间骨折的疗效观察
发布时间：2018-08-11 21:43
【摘要】：背景：针对≥80岁的高龄转子间骨折患者采用内固定还是人工髋关节置换治疗,存在争议。本研究通过对PFNA-II置入和人工髋关节置换治疗高龄股骨转子间骨折的疗效进行对比分析,希望能给临床工作提供一些参考。方法：回顾性分析173例高龄转子间骨折患者的临床资料,其中PFNA-II置入治疗59例,年龄80-94岁；人工髋关节置换治疗114例,年龄80-103岁。对手术时间、失血量、住院和卧床时间、术后并发症和髋关节功能等进行比较。结果：除1例患者术中死亡外,其余172例患者术后随访7-48月。PFNA-II置入组的手术时间(P0.05),术中失血量(P0.0001)和术后隐性失血量(P0.0001)明显小于人工髋关节置换组,但PFNA-II组下地时间较人工髋关节置换组晚(P0.0001),在住院时间、术后并发症和术后一年的髋关节功能方面均无明显差异(P0.05)。结论：1.PFNA-II置入与髋关节置换治疗高龄转子间骨折,PFNA-II置入在手术时间、术中术后失血方面优于髋关节置换,尤其是稳定型骨折；髋关节置换术后卧床时间短,但在术后并发症发生率和髋关节功能方面无明显差异。除大转子和外侧壁均严重破坏的不稳定型骨折以及术前有髋部疾病者,均可考虑首选PFNA-II置入治疗。2.对于严重骨质疏松的不稳定型转子间骨折患者,一直以来都首选髋关节置换。本研究中PFNA-II置入组合并骨质疏松的患者并没有随访到严重的局部并发症,此类患者今后可尝试PFNA-II置入,同时系统地抗骨质疏松治疗。3.围手术期全面检查、处理内科合并症,纠正失血,PFNA-II置入术后注重早期床上功能锻炼,髋关节置换术后注重早期下床功能锻炼,防止长期卧床并发症同时也有利于关节功能恢复。
[Abstract]:BACKGROUND: It is controversial whether internal fixation or hip arthroplasty should be used in the treatment of intertrochanteric fractures in elderly patients over 80 years of age. The clinical data of 73 elderly patients with intertrochanteric fractures were analyzed.Fifty-nine patients aged 80-94 were treated with PFNA-II implantation and 114 patients aged 80-103 were treated with hip replacement. The postoperative follow-up was 7-48 months. The operative time (P 0.05), intraoperative blood loss (P 0.0001) and postoperative occult blood loss (P 0.0001) in PFNA-II group were significantly less than those in the artificial hip replacement group, but the lower floor time in PFNA-II group was later than that in the artificial hip replacement group (P 0.0001), and there was no significant difference in hospitalization time, postoperative complications and hip function one year after operation. Conclusion: 1. PFNA-II implantation and hip replacement in the treatment of intertrochanteric fractures in elderly patients, PFNA-II implantation in the operation time, intraoperative and postoperative blood loss is superior to hip replacement, especially for stable fractures; hip replacement after bed time is short, but there is no significant difference in the incidence of postoperative complications and hip function. PFNA-II implantation is the preferred treatment for unstable fractures with severe destruction of the greater trochanter and lateral wall, and for patients with preoperative hip disease. 2. For unstable intertrochanteric fractures with severe osteoporosis, hip replacement has always been the preferred treatment. Patients with PFNA-II implantation and osteoporosis in this study were not followed up. Severe local complications, such patients can try PFNA-II implantation in the future, while systemic anti-osteoporosis treatment. 3. Perioperative comprehensive examination, treatment of medical complications, correction of blood loss, PFNA-II implantation after early bed function exercise, hip replacement after early bed function exercise, to prevent long-term complications of the same. It is also beneficial to the recovery of joint function.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
[Abstract]:BACKGROUND: It is controversial whether internal fixation or hip arthroplasty should be used in the treatment of intertrochanteric fractures in elderly patients over 80 years of age. The clinical data of 73 elderly patients with intertrochanteric fractures were analyzed.Fifty-nine patients aged 80-94 were treated with PFNA-II implantation and 114 patients aged 80-103 were treated with hip replacement. The postoperative follow-up was 7-48 months. The operative time (P 0.05), intraoperative blood loss (P 0.0001) and postoperative occult blood loss (P 0.0001) in PFNA-II group were significantly less than those in the artificial hip replacement group, but the lower floor time in PFNA-II group was later than that in the artificial hip replacement group (P 0.0001), and there was no significant difference in hospitalization time, postoperative complications and hip function one year after operation. Conclusion: 1. PFNA-II implantation and hip replacement in the treatment of intertrochanteric fractures in elderly patients, PFNA-II implantation in the operation time, intraoperative and postoperative blood loss is superior to hip replacement, especially for stable fractures; hip replacement after bed time is short, but there is no significant difference in the incidence of postoperative complications and hip function. PFNA-II implantation is the preferred treatment for unstable fractures with severe destruction of the greater trochanter and lateral wall, and for patients with preoperative hip disease. 2. For unstable intertrochanteric fractures with severe osteoporosis, hip replacement has always been the preferred treatment. Patients with PFNA-II implantation and osteoporosis in this study were not followed up. Severe local complications, such patients can try PFNA-II implantation in the future, while systemic anti-osteoporosis treatment. 3. Perioperative comprehensive examination, treatment of medical complications, correction of blood loss, PFNA-II implantation after early bed function exercise, hip replacement after early bed function exercise, to prevent long-term complications of the same. It is also beneficial to the recovery of joint function.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
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