高龄股骨转子间骨折PFNA内固定与半髋关节置换手术疗效对比研究

发布时间：2018-09-15 07:04

【摘要】：目的：本课题主要通过收集分析相关资料,从两组手术的术前及术后Harris评分(附表1),手术时间、术中出血量,术后并发症、功能恢复情况、优良率及相关功能评分等方面对比两种治疗方法,分析出针对高龄股骨转子间骨折临床中常用的两种手术治疗方法的优缺点,进而探讨出在临床中更好的、适合患者的治疗方法。方法：选择2012年9月至2014年9月期间在成都中医药大学附属医院住院并符合纳入标准的患者50例。将其随机分成两组,A组和B组,每组各25例。A组采用PFNA内固定术进行治疗,B组采用人工半髋关节置换术进行治疗,两组患者从术前开始采集并记录Harris评分结果；术中观察并记录手术时间、术中出血量；术后观察并记录术后髋关节功能恢复情况、术后下地时间、术后优良率、术后并发症、术后Harris评分。治疗前后(术前术后)观察指标：1、一般观察资料：病例的性别、年龄、手术部位、X线片分型等；2、术前Harris指数评分；3、疗效性指标：通过比较两种不同手术方式的术前及术后Harris评分,手术时间、术中出血量,术后并发症、术后下地时间、术后优良率、术后Harris评分。结果：50例病人均得到有效随访。A组与B组术前、术后Harris评分相比较有统计学意义(p0.05),A组、B组患者术前与术后Harris评分相比较无统计学意义(p0.05),A组与B组手术时间相比较有统计学意义(p0.05),A组与B组术中出血量相比较有明显统计学意义(p0.01),A组与B组下地时间相比较有统计学意义(p0.05),A组与B组术后并发症相比较无统计学意义(p0.05),A组与B组术后优良率相比较无统计学意义(p0.05)。结论：PFNA内固定术与半髋关节置换术均是治疗高龄股骨转子间骨折的有效方法,PFNA内固定术具有手术时间短,术中出血少的优点,针对严重骨质疏松患者效果较好；半髋关节置换术相对下地时间较早,如患者髋关节无明显骨关节炎或患者预期寿命较短时,半髋置换是一种良好的选择。
[Abstract]:Objective: by collecting and analyzing the relevant data, the Harris score (schedule 1), operative time, intraoperative blood loss, postoperative complications and functional recovery of the two groups were analyzed, including the preoperative and postoperative Harris scores (schedule 1), the time of operation, the amount of blood lost during the operation, the complications after operation and the recovery of function. The excellent and good rate and the related functional score were compared. The advantages and disadvantages of the two operative methods in the treatment of intertrochanteric fracture of the femur were analyzed, and the better ones in clinic were discussed. Suitable treatment for patients. Methods: from September 2012 to September 2014, 50 patients who were admitted to the affiliated Hospital of Chengdu University of traditional Chinese Medicine and met the inclusion criteria were selected. The patients were randomly divided into two groups: group A (n = 25) and group B (n = 25). Group A was treated with PFNA internal fixation and group B was treated with artificial hemihip replacement. The results of Harris score were collected and recorded before operation. Observe and record the time of operation and the amount of blood loss, observe and record the recovery of hip joint function, the time of dropping down, the rate of excellent and good, the complication after operation, and the Harris score after operation. Before and after treatment (before and after treatment) observation index: 1, general observation data: case sex, age, surgical site X ray type and so on 2, preoperative Harris index score; 3Therapeutic index: by comparing the preoperative and postoperative Harris scores, operative time, intraoperative bleeding volume, postoperative complications, postoperative landing time, postoperative excellent and good rate, postoperative Harris score. Results all 50 patients were followed up effectively before operation in group A and group B. There was no significant difference in preoperative and postoperative Harris scores between group A and group B (p0.05). There was significant difference in the operative time between group A and group B (p0.05). The amount of intraoperative blood loss in group A was significantly higher than that in group B (p0.05). There was no significant difference in postoperative complications between group A and group B (p0.05). There was no significant difference in the excellent and good rate between group A and group B (p0.05). Conclusion the two effective methods for the treatment of femoral intertrochanteric fracture in the elderly are the internal fixation of the femur with 1% PFNA and half hip replacement. PFNA internal fixation has the advantages of short operation time and less intraoperative bleeding. The effect of PFNA is better for the patients with severe osteoporosis. Hemiarthroplasty is a good choice for patients who have no osteoarthritis or have a short life expectancy.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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