股骨粗隆间骨折术中医源性外侧壁骨折的发生原因及影响

发布时间：2018-09-11 21:13

【摘要】：目的:针对国际内固定协会(Association for the study of Internal Fixation,简称AO/ASIF)分型为A1、A2型股骨粗隆间骨折,目前学界共识的治疗方法是动力髋螺钉(Dynamic Hip Screw,简称DHS)和股骨近端防旋髓内钉(Proximal Femoral Nail Antirotation,简称PFNA),本文统计了经DHS和PFNA治疗的股骨粗隆间骨折患者术中医源性外侧壁骨折的发生率,分析导致该并发症的危险因素,探讨其对患者骨折愈合及髋关节功能的影响,并为临床治疗股骨粗隆间骨折术中医源性外侧壁骨折提供理论依据。方法:采取临床病例分析的方法。回顾分析2013年3月—2015年8月间接受DHS或PFNA治疗且资料完整的55例股骨粗隆间骨折,两组患者随访时间均多余1年。其中PFNA组32例,DHS组23例;用观察性研究方法统计术中外侧壁骨折的发生概率,采用多因素logistic回归分析各指标(年龄、性别、骨折分型、治疗方式及是否有内科合并症)与术中医源性外侧壁骨折的关系;同时采用两独立样本t检验比较二次手术治疗和保守治疗(发生术中医源性外侧壁骨折的患者不接受二次手术治疗)在术中医源性外侧壁骨折患者中的骨折愈合时间和Harris髋关节功能评分等指标。结果:通过统计得出经PFNA或DHS治疗的股骨粗隆间骨折患者术中医源性外侧壁骨折的发生率约为18%;且是否发生术中医源性骨折与患者性别、年龄、治疗方式及是否有内科合并症之间无明显统计学差异(P0.05),而在不同的骨折分型之间存在统计学差异(P=0.018),同时得出骨折分型等级越高,术中医源性外侧壁骨折的风险越高;针对术中医源性外侧壁骨折,二次手术治疗与保守治疗相比较,两者骨折愈合时间及Harris髋关节功能评分均无明显统计学差异。结论:手术治疗(DHS或PFNA)股骨粗隆间骨折均存在术中医源性外侧壁骨折的风险;骨折分型是术中医源性外侧壁骨折的危险因素,骨折分型等级越高,术中医源性外侧壁骨折的风险越高;针对术中医源性外侧壁骨折的患者,二次手术治疗与保守治疗均为有效的治疗方式。
[Abstract]:Objective: to classify the International Association of Internal Fixation (Association for the study of Internal Fixation,) as type A1A _ 2 intertrochanteric fracture. The commonly agreed treatment methods are dynamic hip screw (DHS) and proximal femoral intramedullary nail (Proximal Femoral Nail Antirotation,). The incidence of iatrogenic lateral wall fractures in patients with intertrochanteric femoral fractures treated with DHS and PFNA was analyzed in this paper. To analyze the risk factors leading to the complication, to explore the effect on fracture healing and hip joint function, and to provide theoretical basis for the treatment of iatrogenic lateral wall fracture during intertrochanteric fracture of femur. Methods: to adopt the method of clinical case analysis. 55 cases of intertrochanteric fracture of femur treated indirectly with DHS or PFNA from March 2013 to August 2015 were retrospectively analyzed. The follow-up time of both groups was one year. There were 32 cases in PFNA group and 23 cases in DHS group, and the probability of lateral wall fracture was statistically analyzed by means of observational method and multivariate logistic regression analysis (age, sex, type of fracture). The relationship between treatment and iatrogenic lateral wall fracture; At the same time, two independent samples t test were used to compare the secondary surgical treatment and conservative treatment (the patients with iatrogenic lateral wall fracture did not receive secondary surgical treatment) in the intraoperative patients with iatrogenic lateral wall fracture healing Time and Harris hip function score. Results: the incidence of iatrogenic lateral wall fracture in patients with intertrochanteric fracture treated by PFNA or DHS was about 188.And whether iatrogenic fracture occurred during operation and gender, age, age, There was no significant difference between treatment and internal medical complications (P0.05), but there was statistical difference among different fracture types (P0. 018). At the same time, the higher the grade of fracture classification, the higher the risk of intraoperative iatrogenic lateral wall fracture. For iatrogenic lateral wall fractures, there was no significant difference in fracture healing time and Harris hip function score between secondary surgical treatment and conservative treatment. Conclusion: the risk of intraoperative iatrogenic lateral wall fracture exists in surgical treatment (DHS or PFNA) of intertrochanteric fracture, the classification of fracture is the risk factor of intraoperative iatrogenic lateral wall fracture, and the higher the classification grade is, the higher the classification is. The higher the risk of intraoperative iatrogenic lateral wall fracture is, the more effective treatment is for the patients with iatrogenic lateral wall fracture.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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