经皮加压钢板与股骨近端防旋髓内钉内固定治疗老年稳定性股骨转子间骨折:术后功能恢复、股骨头旋转及固定钉滑脱的比较

发布时间：2018-11-24 18:47

【摘要】：背景:临床中若老年股骨转子间骨折患者出现不稳定性股骨转子间骨折则优先考虑髓内钉治疗;但患者为稳定性股骨转子间骨折时,髓外固定或髓内固定均可起到较好的修复效果,因而临床中如何选取内固定方案仍存在较大争议。目的:探讨经皮加压钢板与股骨近端防旋髓内钉内固定对老年稳定性股骨转子间骨折患者术后功能恢复的影响及患者术后股骨头旋转、固定钉滑脱情况,为临床选择提供依据。方法:将86例老年稳定性股骨转子间骨折患者随机分为2组,经皮加压钢板组患者进行经皮加压钢板内固定治疗,股骨近端防旋髓内钉组进行股骨近端防旋髓内钉内固定治疗。记录手术时间、术中出血量、术后血红蛋白下降量、患者下地负重时间及骨折愈合时间,并在术后4周时使用Harris评分系统对患者功能恢复情况进行评估,此外对患者术后4周时股骨头旋转率、固定钉滑脱量和术后6个月内出现的并发症进行统计。结果与结论:(1)股骨近端防旋髓内钉组患者术中出血量及术后血红蛋白下降量均显著高于经皮加压钢板组(P0.05);(2)2组患者术后4周时Harris评分差异无显著性意义(P0.05);股骨近端防旋髓内钉组下地负重时间、骨折愈合时间均显著短于经皮加压钢板组(P0.05);(3)术后4周时经皮加压钢板组患者股骨头旋转率及固定钉滑脱量均显著高于股骨近端防旋髓内钉组(P0.05);(4)2组患者术后6个月内的并发症发生率差异无显著性意义(P0.05);(5)结果表明,经皮加压钢板和股骨近端防旋髓内钉内固定修复老年稳定性股骨转子间骨折时,患者术后功能恢复及术后并发症无明显差异;但在患者股骨头旋转率和固定钉滑脱量方面股骨近端防旋髓内钉更具优势。
[Abstract]:Background: if unstable intertrochanteric fracture occurs in elderly patients with intertrochanteric fracture, intramedullary nail treatment is preferred. But when the patient is a stable femoral intertrochanteric fracture, the external fixation or intramedullary fixation can play a better effect, so how to select the internal fixation is still controversial. Objective: to investigate the effect of percutaneous compression plate and intramedullary nail fixation on the functional recovery of elderly patients with stable intertrochanteric fracture and to provide evidence for clinical selection. Methods: 86 elderly patients with stable intertrochanteric fracture of femur were randomly divided into two groups. The patients in the percutaneous compression plate group were treated with percutaneous compression plate internal fixation, and the proximal femoral anti-rotation intramedullary nail group was treated with the proximal femoral anti-rotation intramedullary nail. The time of operation, the amount of blood lost during operation, the decrease of hemoglobin after operation, the time of weight loading and the time of fracture healing were recorded. The functional recovery of the patients was evaluated by Harris scoring system 4 weeks after operation. In addition, the rate of femoral head rotation, the amount of fixation nail slippage and the complications occurred within 6 months after operation were analyzed. Results and conclusion: (1) the amount of intraoperative blood loss and the decrease of hemoglobin in the proximal femoral intramedullary nail group were significantly higher than those in the percutaneous compression plate group (P0.05). (2) there was no significant difference in Harris score between the two groups at 4 weeks after operation (P0.05), and the time of weight loading and fracture healing in the proximal femur anti-rotation intramedullary nail group was significantly shorter than that in the percutaneous compression plate group (P0.05). (3) at 4 weeks after operation, the femoral head rotation rate and fixation nail detachment in the percutaneous compression plate group were significantly higher than those in the proximal femoral anti-rotation intramedullary nail group (P0.05). (4) there was no significant difference in the incidence of complications within 6 months after operation between the two groups (P0.05). (5) the results showed that there was no significant difference in postoperative functional recovery and postoperative complications in the treatment of senile stable intertrochanteric fractures with percutaneous compression plate and intramedullary nail fixation. However, the femoral head rotation rate and the amount of fixation nail slippage are superior in the proximal femur anti-rotation intramedullary nail.
【作者单位】： 东南大学医学院附属江阴医院骨科;
【基金】：基金资助:2012年江苏省卫生厅医学新技术引进二等奖(苏卫科教(2012)11号),引进技术名称:经皮加压钢板(PCCP)治疗老年股骨转子间骨折的临床应用~~
【分类号】：R687.3
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本文编号：2354640