高龄不同类型股骨转子间骨折两种手术方式选择的临床研究

发布时间：2018-08-15 17:07

【摘要】：目的比较采用人工股骨头置换与ITST股骨粗隆间/粗隆下髓内钉(ITST Intertrochanteric Subtrochanteric Interamedullary Femoral Fixation,以下简称ITST)治疗高龄不同类型股骨转子间骨折的临床疗效,评价人工股骨头置换及ITST髓内钉两种术式治疗高龄不同类型股骨转子间骨折的效果,为高龄不同类型股骨转子间骨折临床合理选择手术方式提供参考。方法选择广西医科大学第四附属医院关节外科自2011年1月-2014年1月间住院采用人工股骨头置换术或ITST股骨粗隆间/粗隆下髓内钉(ITST)治疗的年龄≥80岁股骨转子间骨折患者为研究对象,根据纳入标准共选出符合条件的患者76例,其中女性42例,男性34例,年龄80-101岁,平均86.3岁。按Evans骨折分型是否稳定分为稳定型组36例和不稳定型组40例,每组再根据选择手术方式的不同分为两组：其中稳定型组人工股骨头置换19例、ITST内固定17例；不稳定型组人工股骨头置换22例、ITST内固定18例,分析比较稳定型与不稳定型股骨转子间骨折患者分别采用人工股骨头置换、ITST在手术时间、术中出血量、术后引流量、下床时间、住院时间、负重时间、术后1个月、6个月和12个月髋关节Harris评分、术后1年内并发症、优良率。对入选患者进行随访并及时记录,资料收集包括查阅病历、电话随访、门诊复诊、上门随访等。结果所有患者均获得随访,随访时间12-32个月,平均19.7个月。稳定型组中在平均手术时间、术中出血量、术后引流量方面,ITST内固定优于人工股骨头置换,两组经统计学处理组间有明显差异(P0.05),两种手术方式在术后下床时间、住院时间、术后6个月、12个月髋关节Harris评分、术后1年内并发症、术后1年髋关节功能优良率方面组间比较无显著性差异(P0.05)；在术后1个月髋关节Harris评分人工股骨头置换优于ITST内固定,负重时间股骨头置换术短于ITST内固定术,差异有统计学意义(P0.05)；在不稳定型骨折组中,两种术式在手术时间、住院时间方面无显著性差异(P0.05),术中出血量、术后引流量方面,ITST内固定优于人工股骨头置换,两组经统计学处理组间有统计学差异(P0.05),人工股骨头置换在下床时间、负重时间、术后1个月髋关节Harris评分方面均显示优于ITST内固定,组间比较有显著性差异(P0.05),人工股骨头置换术后6个月、12个月髋关节Harris评分、术后1年髋关节优良率稍优于ITST内固定,组间比较无明显差异(P0.05),术后并发症方面：两组总并发症发生率股骨头置换为9.09%,ITST内固定为16.67%,组间差别有统计学意义(P0.05)。结论1、对于高龄稳定型股骨转子间骨折(Evans一类Ⅰ型、Ⅱ型),人工股骨头置换及ITST内固定均能取得良好的临床疗效,但人工股骨头置换手术创伤较ITST髓内钉大,对于稳定型骨折,建议选择髓内固定治疗。2、对于高龄不稳定型股骨转子间骨折(Evans一类Ⅲ型、Ⅳ型)、伴有严重骨质疏松、基础疾病多不宜长期卧床的股骨转子间骨折患者,人工股骨头置换在术后早期下床时间、髋关节功能恢复、并发症较ITST髓内钉疗效明显,可尽快恢复患者伤前的髋关节功能,早期下地活动、明显减少卧床时间长而引起的并发症,能更好的提高老年患者的生活质量,是一种有效的手术方法,但应严格把握手术适应症。
[Abstract]:Objective To compare the clinical effects of artificial femoral head replacement and ITST intertrochanteric Subtrochanteric Interamedullary Femoral Fixation (ITST) in the treatment of different types of intertrochanteric fractures in the elderly, and to evaluate the effect of ITST and ITST intramedullary nail in the treatment of the elderly. Methods Artificial femoral head replacement or ITST intertrochanteric/subtrochanteric intramedullary nail (ITST) were performed in the Department of Arthroplasty of the Fourth Affiliated Hospital of Guangxi Medical University from January 2011 to January 2014. According to the inclusion criteria, 76 patients with femoral intertrochanteric fractures aged 80 years or older were selected, including 42 females, 34 males, aged 80-101, with an average age of 86.3 years. They were divided into two groups: 19 cases of artificial femoral head replacement and 17 cases of ITST internal fixation in stable group, 22 cases of artificial femoral head replacement and 18 cases of ITST internal fixation in unstable group. All patients were followed up for 12-32 months, including medical records, telephone follow-up, outpatient follow-up, home follow-up and so on. In the stable group, ITST internal fixation was superior to artificial femoral head replacement in terms of average operation time, intraoperative bleeding volume and postoperative drainage volume. There was significant difference between the two groups (P There was no significant difference in the excellent and good rate of hip function between the two groups (P 0.05) at 1 month after operation, and the artificial femoral head replacement was superior to ITST internal fixation in the Harris score of hip joint, and the load-bearing time was shorter than ITST internal fixation, the difference was statistically significant (P 0.05). There was no significant difference in operation time and hospitalization time (P 0.05). In terms of bleeding volume and drainage volume, ITST internal fixation was superior to artificial femoral head replacement. There was statistical difference between the two groups (P 0.05). Artificial femoral head replacement was superior to ITST in bed time, weight-bearing time, and Harris score of hip joint at 1 month after operation. Internal fixation, there was a significant difference between groups (P 0.05), 6 months after artificial femoral head replacement, 12 months after the Harris hip score, 1 year after the hip joint good rate slightly better than ITST internal fixation, there was no significant difference between groups (P 0.05). Postoperative complications: two groups of total complications rate of femoral head replacement was 9.09%, ITST internal fixation was 16.67%. Conclusion 1. For elderly patients with stable intertrochanteric fractures (Evans type I, type II), artificial femoral head replacement and ITST internal fixation can achieve good clinical efficacy, but the surgical trauma of artificial femoral head replacement is greater than ITST intramedullary nail. For stable fractures, intramedullary fixation is recommended. For elderly patients with unstable intertrochanteric fractures (Evans type III, type IV) accompanied by severe osteoporosis, most of the underlying diseases are not suitable for long-term bedridden intertrochanteric fractures, artificial femoral head replacement in the early postoperative bed time, hip function recovery, complications than ITST intramedullary nail curative effect is obvious, can recover patients as soon as possible before injury. It is an effective surgical method to reduce the complications caused by prolonged bed rest and improve the quality of life of elderly patients. However, the indication of operation should be strictly controlled.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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